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A 



Digest of External Therapeutics 



With Numerous Formulae Arranged 
for Reference. 



BY 



EGBERT GUERNSEY RANKIN, A. M., M. D. 

Physician to the Metropolitan Hospital, Department 
of Public Charities, New York. 



BOERICKE & RUNYON CO. 
NEW YORK. 



0QT4-1899 






43210 



s> N 




■T 



^/«3 



COPYRIGHT 

BY 

BOKRICKE & RUNYON CO. 

1899. 



.1? 



X- 



T WO COPIES RECEIVED. 




T. B. & H. B. COCHRAN, PRINTERS, 
LANCASTER, PA. 



SECOND COPY, 



This Book is Dedicated 

to 

EGBERT GUERNSEY, M. D., 

President of the Medical Board of the 

Metropolitan Hospital, 

New York, 

With the Affectionate 

Regard of the 

Author. 



PREFACE. 



It is not the purpose of this book to give undue 
prominence to external therapeutics, but to present 
the subject in a condensed and easily accessible form. 
No attempt has been made to cover completely so 
wide a field . 

The remedies and remedial measures include those 
which are the more important and generally ac- 
cepted, and have been selected from well known and 
recent writers. A wider range of authorities might 
have been presented, but it was found that after a 
certain number had been searched, while new names 
were added, new subject matter was not thereby 
obtained. 

The following writers have been so frequently cited 
as authorities that the author desires to acknowl- 
edge his indebtedness to them : Goodno, Tyson, 
Anders, Pepper, Allbutt, Ruddock, and the Twentieth 
Century, Practice of Medicine; Foster, Barthe- 
low, Ringer, Hare, Therapeutics ; Harrison Allen, 
Local Therapeutics ; Carleton, Bangs and Harda- 
way, Genito-Urinary Diseases ; Van Harlingen, Kip- 
pax, Jackson, Crocker, Hardaway, Hyde, Shoemaker, 
Unna, Diseases of the Skin ; Burt, Shoemaker, Ma- 
teria Medica; Keating and Coe, Southwick, Cowper- 
thwaite, and Dudley, Diseases of Women; Bosworth, 
Lennox Browne, Ivins, Ingalls, and Bishop, Diseases 
of Nose and Throat; Burnett, Boyle, McBride, 



VI PREFACE. 

Bacon, Roosa, and Buck, Diseases of the Eye and 
Ear; Kelse}-, the Allinghams, Andrews, and Gant, 
Diseases of the Rectum and Anus ; Jacobi and Holt, 
Diseases of Children ; Wyeth, Dennis, Park, Treves, 
Holmes, and Helmuth, Surgery ; Treat's Interna- 
tional Medical Annual for 1896, 1897 and 1898, 
and Sarjous' Annual. 

E. G. R. 

226 Central Park South, 

West Fifty -Ninth Street, 

New York. 
Sept. 1, 1899. 



NOTE. 

The initials and abbreviations -which appear at the end of 
paragraphs throughout this work are explained by the Refer- 
ence Key on page 621. 



Digest of External Therapeutics. 



ABSCESS. 

ACUTE ABSCESS:— 

If seen early, suppuration may sometimes be pre- 
vented. The following are recommended with this 
end in view: 

Rest and elevate the part ; cleanse the surface with 
antiseptic soap and spray with a 2 per cent, solution 
of Carbolic acid or Hydrogen Peroxide for ten min- 
utes every two hours, or apply compresses saturated 
in hot solutions of corrosive sublimate i to 4,000. If 
the lesion is situated on the lower extremity the same 
solutions may be employed in the form of baths. 
When pain is very severe the anode sponge of a gal- 
vanic battery, saturated in a 10 per cent, solution 
of cocaine, may be applied for five minutes every 
three hours, with a current not exceeding five mill- 
iamperes ; during the intervals apply warm fomenta- 
tions with borated or camphorated water or an in- 
fusion of poppies. (Sj.) 

Menthol: — 10 to 50 per cent, ethereal solutions 
painted on with a camel's hair brush two or three 
times a day control small abscesses. (Al.) 

Carbolic Acid: — See carbuncles and boils. 

Nitrate of Silver: — This drug is very highly praised 
by Mr. Higginbottom, the author of the method, 
who regards it as efficacious in subduing external in- 



2 DIGEST OF EXTERNAL THERAPEUTICS. 

flammation: " The affected parts should be well 
washed with soap and water then with water alone 
to remove every particle of soap, as soap decomposes 
nitrate of silver, then wiped dry with a soft towel. 
The concentrated solution of nitrate of silver, 4 scru- 
ples to 4 drachms of distilled water, is then applied 
two or three times on the affected surface and beyond 
it on the healthy skin to the extent of two or three 
inches. The solution may be applied with a soft 
piece of linen on the end of a stick. In about twelve 
hours it will be seen whether it has been well applied. 
If any inflamed part is unaffected the solution must 
be immediately reapplied." (B.) 

The f ollowing is recommended for phlegmonous in- 
flammation ; under its influence, together with moist 
heat, infiltration assumes a more kindly hue and pus 
is sometimes absorbed : 

Ichthyol, 10 parts. 
Resorcin, 5 parts. 

Mercurial Ointment, 35 parts. 

Lanolin, 50 parts. (Pk.) 

Alum and Plumb. Acetate: — The following (for- 
mula of Von Bulow) is highly endorsed as effective 
for subduing local inflammation, it is non-poisonous, 
astringent, mildly antiseptic, and almost non-irritat- 
ing: 

Alumin.. ^vi. 

Plumb. Acetat., 3^ x ss - 

Aquae, Oij. 

Filter and allow to stand twenty hours before using. (W. C.) 

Cold: — In local inflammations is generally preferred 
to heat by patients ; use ice bag or Leiter'sxoil. (W.) 

Continuous Antiseptic Applications: — When the 
skin is broken, in place of poultices apply layers of 
gauze soaked in solutions of bichloride and cover with 



ABSCESS. 3 

rubber dressing. This -will act somewhat as a poul- 
tice. (W. C. ). A hot water bag may also be applied 
over the gauze. 

Poultices: — Will sometimes abort, as well as hasten 
maturation ; they are generally made of flaxseed 
meal, and should be applied only up to the time of 
suppuration, never after, or to open incisions. (W. C.) 

Tr. Opii. or Tr. Bell.: — Poured over poultices use- 
ful to relieve pain. 

If suppuration is unavoidable, incise as soon as 
presence of pus is ascertained. For anaesthesia of sur- 
face : Cocaine 5 per cent, solution, twenty drops sub- 
cutaneoushy near the abscess ; spray of ./Ethyl Chlor- 
ide, Ether or i*Ethyl Bromide ; the latter especially 
valuable. (Sj.) 

Incision: — The parts should first be thoroughly 
cleansed and rendered aseptic. The incision should be 
planned so as to run parallel with important struct- 
ures, and of sufficient depth to freely expose the 
cavity; the opening should be made in as dependent a 
portion as possible to facilitate drainage. Abscess 
of the limbs should be opened longitudinally, in those 
of the anus and breast, the incisions should radiate 
from the part. Deeply seated abscesses and those 
near large vessels should be opened by Hilton's 
method ; this consists of making an incision through 
the skin and deep fascia ; a director is then pushed into 
the abscess cavity, the escape of pus showing when 
this is reached ; a pair of closed dressing forceps is 
then inserted, and withdrawn with distended blades, 
thus enlarging the opening ; a counter opening may be 
made if possible when the cavity is deep, and a drain- 
age tube inserted. (Whar.) 

After evacuation of pus, some surgeons irrigate the 



4 DIGEST OF EXTERNAL THERAPEUTICS. 

cavity ; others leave it to nature, packing with iodo- 
form gauze for the first twenty -four hours ; at the 
second dressing the cavity is irrigated. (W. C.) 

The following solutions are used for irrigation : 

Mercuric Bichloride:— 1-4,000 or 5,000. 

Carbolic acid:— 1-40 or 50. 

Hydrogen Peroxide: — 1-8, or stronger. 

Boric Acid: — Saturated solution. 

Alumnol: — 1-5 or 10. 

Dressing: — If the abscess cavity is small no drain- 
age tube is necessary; a small piece of gauze should be 
placed between the edges of the incision to prevent 
adhesion. When the cavity is large a drainage tube 
or a substitute, such as a strip of iodoform gauze, 
should be introduced to the bottom of the cavity, and 
fastened with a safety pin at the surface. (Whar.) 
The dressing should consist of a strip of gauze soaked 
in a bichloride solution laid directly over the incision, 
over this, layers of cotton moistened with a bichloride 
solution, then dry gauze ; over this in turn a piece of 
protective or oiled silk, and the whole held in place 
by a roller bandage. Some surgeons use plain steril- 
ized cotton, but, in view of the discharge, the bichlor- 
ide cotton is preferred by many. (W. C.) In excep- 
tional cases an aseptic poultice, made of flaxseed 
meal, and a solution of bichloride of mercury, 1- 
5,000, may be applied. The frequency of changing 
the dressing will depend upon the amount of dis- 
charge. At each dressing the cavity may be irrigated, 
and the drainage tube shortened as required. (W.) 

COLD ABSCESS:— 

The majority of abscess of this varietur are tuber- 
cular, though some may be syphilitic. Ordinary 



COLD ABSCESS. 5 

tubercular abscesses contain pyogenic membrane, 
but the syphilitic do not. These abscesses should 
be opened with every antiseptic precaution. (A 1 .) 

Aspiration should generally be preferred, as evacu- 
ation by this method avoids shock and haemorrhage ; 
a large needle should be employed to prevent occlu- 
sion by masses of thickened lymph. After the removal 
of pus irrigate freely with a saturated solution of 
Boric acid or Iodoform. The puncture should be 
carefullv sealed with iodoform gauze and collodion. 
(A.) 

Another method is as follows : Withdraw the pus 
with an aspirator, then inject a 5 percent, solution of 
Carbolic acid, afterwards aspirate, and renew the pro-' 
cedure until the solution comes out clear, then apply 
Lister's bandage with slight pressure. Four days 
later the same treatment ; about five sittings are said 
to be required . Iodoform may be injected in the same 
way, but should not be renewed as long as the remedy 
is excreted in the urine (for formula see paragraph 
on this drug). Boric acid, 4 per cent, solution, may 
also be used in this manner. (Sj.) 

Puncture: — This method of evacuating the contents 
of a cold abscess is often preferable to aspiration, 
from the fact that masses of lymph are liable to oc- 
clude the canula of the aspirator. The puncture is 
made with a bistoury ; the opening enlarged with a 
director and antiseptic irrigations and dressings ap- 
plied as mentioned. (Whar.) 

Incision and Curetting: — Make a free incision and 
curette the cavity thoroughly with Volkm ami's 
curette, then irrigate with Carbolic acid, 5 per cent, 
solution, insert a long drainage tube, and stitch up 
the wound close to it. (Sj.) This method is to be 



6 DIGEST OF EXTERNAL THERAPEUTICS. 

considered when aspiration has failed; it is suited 
to abscesses with few ramifications, and those easily 
accessible to the curette. (A.) 

Hyperdistension of the walls of an abscess cavity 
with an antiseptic fluid, after the removal of pus, 
was recommended by Mr. Callender. (A.) 

Iodoform: — Formulae for injection: 

Iodoform, 10 parts. 

Glycerine, 20 parts. 

Mucil. Gum Acacia, 5 parts. 

Carbolic Acid, 1 part. 

Water, . 100 parts. 

Inject 2 or 3 oz. at intervals of three or four weeks. 

- This is safe as far as iodoform poisoning is con- 
cerned. (A.) Billroth's formula: 

Iodoform, 3*- 

Glycerine, §i. 

A 5 per cent, ethereal solution is also recommended ; 
it causes considerable pain ; not more than three 
ounces should be injected. (A.) 

Iodoform, 1 part. 

Ether, 5 parts. 

Distilled Water, 5 parts. 

(Mosetig-Moorhof, Verneuil.) 

Iodoform poisoning may be prevented by subject- 
ing it and its excipient (omitting of course, the ether) 
to a temperature 212°. (Sj.) 

Iodol: — As a substitute for iodoform has been rec- 
ommended on account of the absence from odor but 
it is not as effective. (See Adenitis.) 

Resorcin: — Cavities may be flushed with a 5 per 
cent, solution, and afterwards dressed -with the 
powder. (Al.) 



ACNE SIMPLEX. 7 

Iodine: — Solutions sometimes employed after free 
incisions, especially for scrofulous abscesses. (B.) 

Phosphate of Lime: — Gauze soaked in a 5 per cent. 
solution for packing cavity. (Al.) 

Potass. Permang.: — ^i-Oj of water to correct 
fetor. (B.) 

Oleate of Mercury, a 5 per cent, ointment with 
Morphia diminishes pain in indurations due to old 
abscesses, and prevents formation of new ; to be 
smeared on, not rubbed in. (R.) 

Naphthalene: — The following formula is recom- 
mended for injection : Naphthalene, sii ; alcohol, |ii ; 
aq., §iv; the water should be added hot and the whole 
filtered, since the crystals will clog the syringe ; the 
solution must be warmed before using ; after evacua- 
tion the cavity should be gently distended. (Al.) 

Essence of Cloves: — 10 per cent, in olive oil, in- 
jected into cavity. (F.) 

For dressing, the substitutes for iodoform, as 
Loretin, Europhen, Boric acid, Methylene Blue, etc. 



ACNE SIMPLEX. 

Local treatment is of great importance. In a 
limited number of cases when there is much heat, red- 
ness, and acute inflammation, mild washes and bland 
ointments, such as those for eczema of the face are 
indicated. 

Bathing with hot water, and the use of medicated 
soaps, such as Sulphur, Ichthyol, Bichloride of Mer- 
cury, or Salicylic acid, should precede the use of all 
lotions and ointments. The soap should be used once 
daily, also plain hot water alone. This will often 
answer for mild cases with little irritation. 



8 DIGEST OF EXTERNAL THEEAPDUTICS. 

Boric Acid: — Saturated solutions in 96 per cent, 
alcohol, sopped on or applied with a compress, may 
be employed with advantage after the use of medi- 
cated soaps. (Vn.) 

Hydrarg. Bichlorid.:— This is indicated when 
stronger remedies are required : 

Hydrarg. Bichloridi, grs. vi-xii. 

Alcohol., 5i- 

Aq. Destill., giv. 

Dilute with water at first and gradually increase. 
The patient should be warned against possible irri- 
tating effects. (Yn.) 

" Hebra's Oriental Solution," a popular remedy, is 
as follows : 

Hydrarg. Bichloridi, 
Aq. Destill., 
Succi Limonis, 
Albumin, ovi, 
Sac. Alb., 

The following is much used : 

Hydrarg. Bichloridi, 

Tr. Benzoin., 

Etnul. Amygdal. Amar., 

" Gowland's Lotion :" — One part each of Hydrarg. 
bichloride, and Ammon. chloride, and 200 of emul- 
sion of bitter almonds ; this forms an excellent prepar- 
ation. (Yn.) 

Sulphur: — Serviceable in more severe cases, and one 
of the most effective remedies. 

The addition of camphor is sometimes desirable ; 
the following makes a stimulating lotion : 

Sulphur. Sublimat., 5"- 

Tr. Camphor., 5'- 

Aq. Destill., §iv. (Ga.) 



grs. 


Villi 


3 iv 




No. 


ii. 


No. 


iv. 


oi- 




grs. 


iv— viii 


5ss 


-3i- 


ad, 


3iv. 



ACNE SIMPLEX. 9 

Another combination forming an ointment is: 

Sulphur, praecipitat., 5*- 

Pulv. Camphor., grs. xx. 
Ung. aq. Rosae, 

Petrolat., aa ^\y. 

Kummerfield's Lotion: — Forms an excellent wash 
in many forms of the disease ; it is as follows: 

Sulphur, praecipitat., 5 u r~i v - 

Pulv. Camphor., gr. x-xx. 

Pulv. Tragacanth., 9i-ii. 

Aq. Calcis, 

Aq. Rosae, aa §ii. (Al.) 

Other useful formulae are as f ollows : 

Sulphuris, 5^- 

Glycerini, 3i- 

Alcoholis, 3i v - 

Aq. Rosae, giv. (Kp.) 

Or 

Sulphur, praecipitati, 3*- 

JEther., 3 V - 

Alcohol., giv. (Vn.) 

When the skin is very sluggish the f ollowing : 

Potass, sulph., £)i. 

Tr. Benzoin., 3*- 

Glycerini, 3i ss - 

Aq. Rosae, ad §iv. (Vn.) 

Or 

Potass. Sulphuret., 

Zinc. Sulphat., aa. 3*- 

Aq, Rosae, giv. 

Dilute at first and gradually use stronger, not suited to irri- 
table skins. (Sh.) 

Vlemingckx's Solution : — (See Appendix II. for for- 
mula.) One of the best preparations for acne sebor- 
rhceca. Of this take one part, and ten of water and 
mix in a bottle; weaker solutions should be used on 
sensitive skins. Wash the face gently until a slight 



10 DIGEST OF EXTERNAL THERAPEUTICS. 

burning sensation results, allow lotion to dry on and 
wash it off the next morning with soap and water ; 
once or twice a week the mixture is made stronger. 
(B.H.) 

Sulphur and Mercury should never be combined. 

For the papular variety: 

In mild cases lather the part with castile soap and 
hot water, and rub well with a towel. The lather 
may be mixed with fine sand or marble dust, or sand 
soap may be used. 

When comedones are deeply seated and numerous, 
they should be squeezed out after lathering, using the 
thumb protected with a handkerchief or a comedone 
extractor. (B. H.) 

Sapo Viridis: — After removal of comedones this 
may, in solution, be applied by means of a piece of 
coarse flannel, using the following formula : 

Sapo. Virid., §i. 

Alcohol, fort., §ii. 

Aq. Destill., giii. 

Spts. Lavandul, 3 SS - 

Rub into the skin thoroughly and wash off the next 
morning. This may be continued until redness and 
scaling is produced when bland salves should be ap- 
plied. When the inflammation has disappeared the 
green soap may be used again, if necessary, or if the 
larger comedones have disappeared, apply Vlem- 
ingckx's solution. (B. H.) 

Another method consists in rubbing on the green 
soap briskly for a few minutes, and then washing it 
off and powdering with starch or anointing with cold 
cream. (Vn.) 

Ichthyol: — Recommended by Unna, who used an 
ichthyol soap for washing the parts night and morn- 



ACNE SIMPLEX. 11 

ing then applied the following: Ammon. sulpho- 
ichthyolat., (grs. xii— ^ii), Alcohol. 96 per cent., 
^Ether., aa siv. The application can remain on over 
night. If it is too irritating it should be removed 
after half an hour, and the following ointment applied: 
Acidi Boric, ^ss, Acidi salicylic, grs. x, Ung. Zinci 
oxid., ^i. It is advisable to begin with the weaker 
solutions of ichthyol. (Vn.) 

Resorcin: — A good remedy; 15-20 per cent, paste 

Resorcini, 3i~3^ ss - 

Zinc. Oxid., 

Amyl., 

Maydis, aa 5"- 

Ung. Aq. Rosae, gss. 

Ol. Olivae, q. s. 

Apply at night at first for five minutes, then re- 
move with a dry cloth; continue applying each night, 
lengthening the time until forty-five minutes have 
been reached. A good deal of redness and scaling 
may be produced, which should be treated in the 
same way as described in the use of green soap. 
(B.H.) 

A milder preparation suited to less severe cases, 
when inflammation and congestion have partly sub- 
sided, is as follows : 

Resorcini, ^[. 

Glycerini., 3*- 

Aq. Aurant. Flor., 5 V1 - 

Spts. Vini Rect., ^iii. (Kp.) 

Naphthol: — In severe cases the following paste may 
be applied: ,5-Naphtholi, Biiss, Sulphur, praecipit., 
3ss, Lanolini, Sapo.. Vir., aa 3ii. 

Allow to remain on fifteen to thirty minutes every 
night, then remove with cotton soaked in olive oil 



12 DIGEST OF EXTERNAL THERAPEUTICS. 

and wash with soap and water. A severe inflamma- 
tion and desquamation can be produced by this paste 
in a few days. As soon as irritation is severe, which 
may be after two or three applications, the remedy 
must be discontinued, and cold cream applied. 
(B. H.) 
A milder preparation is as follows : 



Naphtholi, 










Catnphorse, 










Resorcini, 








aa grs. viii. 


Snlphuris, 








• grs. xlv. 


Sapo. Viridis, 








grs. xii. 


Vaselini, 








5v. 


Allow to remain on 


over 


night. 


(Vn.) 





In acne indurata, Shoemaker recommends the fol- 
lowing line of treatment : All glandular and subcu- 
taneous abscesses should be punctured, and the con- 
tents removed; a bistoury should be used, which 
must enter deeply. Ten to fourteen sittings will be 
necessary. The haemorrhage which will be consider- 
able may be controlled by cold compresses. Haemor- 
rhagic and flabby infiltrations should be scraped out 
with a sharp spoon, and fringes of skin removed with 
the scissors. At the end of ten to fourteen days when 
all large fluctuating nodules have been removed, and 
small ones only remain, the following is advised : (1) 
Mechanically express comedones and incise incipient 
abscesses ; (2) Employ constant and vigorous wash- 
ing with soap (toilet soap, soft soap, spts.sapo.kal., 
iodine, sulphur, naphthol, etc.), combined with va- 
por and douche baths; (3) Apply such remedies as 
will cause rapid exfoliation of the epidermis as well 
as of the lining cells of the sebaceous glands, thus re- 
lieving them of their contents and causing contrac- 
tion ; for this purpose employ the soaps just men- 



ACNE SIMPLEX. 13 

tioned, together with sulphur and mercurial plasters 
and cold douches ; (4) Protective ointments, lotions 
and powders. (Sh.) 

Van Harlingen recommends that after opening 
larger suppurating lesions, the contents should be 
gently expressed and pure Ichthyol introduced into 
the cavity on a small probe or sharpened stick ; he 
adds that too much pressure should be avoided in 
emptying the pustules as it is possible thereby to 
create new foci of suppuration. 

Carbolic Acid: — 5 per cent, solution, for application 
to the skin after removal of comedones. (B. H.) 

Salicylic Acid: — 1—3 per cent, solution in alcohol 
especially indicated for the pustular form. (B. H.) 

A 50 per cent, plaster may be applied after opening 
pustules. (T. 96.) 

Vlemingckx's Sol. Spts., Sapo. Kal., Resorcin, and 
Naphthol. may also be used with advantage in this 
variety of the disease. (B. H.) 

Oleate of Mercury: — 5 per cent., 3 drachms, olive 
oil 1 ounce, well mixed and applied at night is useful 
in obstinate cases. (Kp.) 

Massage with a rubber ball was suggested by J. N. 
Hyde for indolent and intractable cases. The skin is 
first operated upon with a disinfected needle, and 
comedo extractor, until all pustules and sub-epider- 
mic foci and prominent comedones are removed. The 
surface is then rendered aseptic by a solution of bi- 
chloride of mercury or formalin, 1—2 per cent., the 
latter preferred. The massage ball is then firmly ap- 
plied, and by deep pressure other comedones are 
brought to view, and then removed. Lastly mas- 
sage of the surface using the ball with salicylicated 
cocoa oil or sulphur ointment. (T. 98.) For hast- 



14 DIGEST OF EXTERNAL THERAPEUTICS. 

ening the disappearance of scales which follow severer 
types of the disease, massage is one of the best reme- 
dies ; the f ollowing ointment is also highly recom- 
mended : 

Hydrarg. Prsecipit. Albse, 5^- 

Bismuth. Subnit., 9iiss. 

Ung. Glycerini, 3x. (B. H.) 

Eichhoff's Sulphur Camphor, or Balsam Peru 
Soaps maybe used as an ordinary soap in mild cases, 
or well rubbed on in severe. (T. 96.) 

Sea baths, Hygiene and Exercise are of great im- 
portance. (Ga.) 



ACNE ROSACEA. 

Sulphur, Resorcin, Naphthol, Green Soap, Salicylic 
acid and Ichthyol, as used in acne simplex, are appli- 
cable to this form of the disease, especially in the 
earlier stages ; hyperasmia, small papules and pus- 
tules will usually disappear under this treatment. 
(B. H.) 

In the first stage soothing remedies are indicated, 
viz: 

Plumb. Carbonat., 3*- 

Pulv. Marant., 5*- 

Hydrarg. Ammoniat., grs. x. 

Ung. Simplicis, §i. 

Or 

Plumb. Acetat., grs. v. 

Zinc. Acetat., grs. x. 

Aq. Rosse, S iv - 

Apply with a piece of old linen, for an hour or two, night and 
morning. ( Sh. ) 



ACNE ROSACEA. 15 

Hydrarg. Bichlorid.: — Gr. V^— ij, alcohol j§i, or an 
ointment. (Yn.) 

In the second stage : 

Hydrarg. Ammoniat.: — Gives good results; rise 20 
-25 grains to Ung. Aq. Rosae, 1 ounce. (Sh.) 

Sulphur: — Will be found one of the best applica- 
tions. Vlemingckx*s solution (B. H.), or an oint- 
ment of 1-2 drachms to 1 ounce of Ung. Aq. Rosas, 
may be used. Kummerfield's lotion (see acne) also 
forms an effective remedy ; it may be applied from 
once to several times a day. If a sensation of draw- 
ing is caused the preceding ointment of sulphur may 
be applied in small quantities after using the lotion. 
(Vn.) 

Ichthyol: — More effective here than in simple acne. 
It may be used in ointments, lotions, or salves, in the 
strength of 5-10 per cent., and in most cases is 
said to be all that is required. (B. H.) Unna recom- 
mends equal parts of Ammon. Sulpho-ichthyolate, 
Distilled Water and Glycerine. 

Ergot.: — Forms an effective appication, viz : 

01. Ergot., 

Glycerini, aa 5 SS - 

Ext. Belladonnas, 5i. (Sh. ) 



Or, 



Ex. Ergotae, 3 SS - 

Cocain. Hydrochlorat., grs. v. 

Plumb. Carbonat., . 5 SS - (Sm. 



Iodine: — Kaposi recommends the following for ap- 
plication eight to twelve times daily for three or four 
days, the part to be immediately covered with gutta 
percha (B. H.): 

Iodi Pur., 

Potass. Iodid., aa 3i- 

Glycerini, 3^- 



16 DIGEST OF EXTERNAL THERAPEUTICS. 

Among other remedies used are : 

Mercuric and Salicylic acid Plasters and Chrysa- 
robin 3 per cent, in liquid gutta percha. (B. H.) 

Poultices: — Sometimes when other means have 
failed hot fomentations, followed by soothing appli- 
cations, such as oleate of bismuth are beneficial. (Sh.) 

Puncture of the Skin with fine needles or a knife 
followed by sponging in hot water will relieve the 
congestion in chronic stages of the disease. This 
procedure may be repeated at intervals of five to 
seven days. After each operation bland astringent 
applications should be made. (Sh.) 

Scarification: — When the dilated blood vessels are 
very prominent, and the tissues hypertrophied, linear 
scarification may be performed, using a small bistou- 
ry or a Vidal's scarifier. A large number of sittings 
are frequently necessary. Local anaesthesia may be 
produced by freezing. The bleeding after operating 
may be controlled by cold compresses. Scarification 
is advised as promising a greater degree of success 
than any other method. (Vn.) 

Electrolysis: — Recommended by Hardaway under 
conditions which indicate scarification, using a 
fine needle attached to the positive pole while the 
patient grasps the negative. Better results, how- 
ever, are obtained from the positive pole. A few 
sittings will cause shrinkage of the vessels. A mild 
current is used, and the pain is trifling. Scars rarely 
result. (B. H.) 

ADENITIS. 

Iodine: — The tincture, painted on, is a useful and 
often effective remedy. (F.) 
Belladonna: — The officinal ointment alone, or com- 



ADENITIS. 17 

bined with officinal iodine ointment, equal parts, or 
with equal parts of iodide of lead ointment. Combi- 
nation appears to increase its efficacy. (Al.) 

Cadmium Iodide: — May be substituted for iodine, 
using 1 drachm— 1 ounce of lanolin ; it does not stain 
the skin but is not so effective. (Al.) 

Lead Iodide: — The officinal ointment rubbed in 
twice daily, in non-suppurating forms, does not pro- 
duce so much cutaneous irritation as other iodine 
preparations. ( Al.) 

Iodoform Injection into cavity of gland, as recom- 
mended in abscess. (See that subject). 

Iodol: — A substitute for iodoform, non-odorous, 
but less effective, has given good results in suppurat- 
ing adenitis. After scraping, it may be employed in 
the form of powder or solution. Mazzoni's formula 
for the latter is Iodol, 1 part ; Alcohol, 14 parts ; 
Glycerine, 32 parts. (Al.) 

Ichthyol: — 10—60 per cent, applications give good 
results and relieve pain. (F.) 

Essence of Cloves: — 10 per cent, solution in olive 
oil, from 30-300 drops injected once a week, the 
frequency of injection depending upon the rapidity 
with which the oil is absorbed, has benefited tuber- 
culous glands. (F ) 

Mercurial Ointment: — For local indurations and 
enlargements, especially those of bubo and of lym- 
phatic glands. It is usually applied by inunction, the 
compound ointment containing camphor, which is 
thought to promote the absorption of mercury, may 
be preferred. (F.) 

Mercurial Plaster: — Applied over enlarged glands 
tor its resolvent action. (F.) 

Phytolacca Decandra: — The solid extract spread on 



18 DIGEST OF EXTERNAL THERAPEUTICS. 

cloth is used to prevent the formation of pus. (F.) 
Naphthalene: — Has been advised as a substitute for 
iodoform. (See abscess.) 

Teucrium Scordium:— An aqueous extract called 
Teucrin is furnished in hermetically sealed tubes, 
each containing 45 grains for use by injection. This 
is injected around the tubercular gland, the con- 
tents of the tube being used. The remedy will set up 
an inflammatory action around the gland, and bring 
about the expulsion of the tubercular deposit. It has 
been used extensively by Prof. Von Moisteg-Moorhof . 

(p.) 

Carious Teeth: — In children have been found to be 
a medium by which tubercular bacilli can gain an 
entrance and affect the cervical and submaxillary 
glands ; from this it follows that such teeth should 
be extracted or filled. (T. 98.) 

For suppurating adenitis. (See abscess.) 



AGALACTIA. 

Castor Oil: — A strong decoction of the leaves ap- 
plied by means of a soft cloth often proves successful. 
(T. 97.) Irritation of Gland:— Draw out the milk 
with pump. Hot Applications:— Decoction of Marsh 
Mallow or Broom. (Bt.) 

ALOPECIA. 

Local stimulation constitutes the general plan of 
treatment. If the scalp is dry the application should 
be made up with oil ; if greasy, with alcohol. 

Spts. Sapo. Vir.:— (Sapo. vir. giv — alcohol, ^ii) May 



ALOPECIA. 19 

be used once or twice a week for shampooing ; this 
removes accumulations of sebum and scales, and 
stimulates the scalp ; after its use, thoroughly dry the 
scalp and apply the following : 

Acid. Carbolic, grs. xv. 

Glycerini, 3ii- 

Aq. Cologn., * ad gi. 

This may be applied by means of a comb and 
Barnes' dropper, rubbing in well with a soft brush. 
Go over the scalp in a line carefully to avoid making 
a mess which such application will do if rubbed in 
carelessly. (Vn.) 

Pilocarpine: — This drug seems to have an action in 
promoting growth of the hair. The following prep- 
arations are recommended : 

Pilocarpin. Nitrat., grs. ii. 

Quinise Hydrochlor. , grs. viii. 

Glycerin., 3"- 

Aq. Rosas, 5vi. (M. W.) 

Lassar's ointment, grs. xv-^i (T. 97) ; or made up 
as follows : 



Pilocarpin. hydrochlor. 


5ss. 


Vaselini, 


3v. 


Lanolini, 


S«. 


01. Lavandulae, 


gtts. xxv. (Ja.) 



Cantharides: — This remedy enters largely into the 
formation of " hair tonics," though it is claimed that 
their effect is not increased by its presence. (F.) It 
is none the less mentioned by most dermatologists 
and is usually applied in the proportion of 1-3 
drachms to the ounce. 

Acetic Acid: — Has some influence ; it may be used 
in Cottle's formula : 



20 DIGEST OF EXTERNAL THERAPEUTICS. 

Acid. Acetici, gss. 

Pulv. Borici, 3*- 

Glycerini, 5iii- 

Spts. Vin. Rect., gss. 

Aq. Rosae, ad 3viii. (B. H.) 

Quinine: — Largely used. Its influence is probably 

that of a local stimulant. Bulkley recommends : 



Quin. Sulph., 






Bi- 


Zinc. Sulphat., 






grs. x. 


Tr. Cantharidis, 






3iii. 


Alcohol, (absolute), 






Glycerini, 




aa 


3iv. 


Spts. Myrcise, 




ad 


Svi. 


:her formula 


(Gerhard's) 


is the f 


ollowi 


Quin. Sulph., 






3ss. 


Tr. Cantharidis, 






3i- 


Spts. Ammon. Aromat., 




Si- 


Ol. Rosmarini, 






gtts. V, 


Ol. Ricini, 






giss. 


Spts. Myrcise, 






gvss. 



(Al.) 



Apply with a stiff brush two or three times a day. (Sn.) 

Liq. Ammonise: — (Pure or diluted.) The follow- 
ing was a favorite of Wilson : 

Ol. Amygdalae, 

Liq. Ammoniae, aa £i. 

Spts. Rosmarini, aa 

Aq. Mellis, giii. (Wa.) 

Medicated Soaps: — EichhofFs Salicylic Acid, Sul- 
phur, Resorcin and Tar, useful for shampooing. (Vn.) 

Resorcin: — When there is much scaliness first wash 
with tar soap, and apply a solution of 30-60 
grains to 13 ounces of spts. myrcia. Lassar recom- 
mends the following method : First wash the scalp 
with tar soap, then rub in well a 2 per cent, solu- 
tion of Corrosive Sublimate ; this is followed by the 



ALOPECIA AREATA. 21 

application of Naphthol 1—3 per cent, in alcohol, to 
dry the hair, the scalp is finally anointed with a 2 per 
cent, solution of Salicylic Acid in olive oil. (Vn.) 
For use after fevers, the following: 

Sodii Biborat., grs. xxiv. 

Acidi, Salicylic, grs. viii. 

Tr. Cantharidis, - 5^- 

Spts. Myrciae, 

Aq. Rosae, aa %\. 

Aq. Bullientis, ad giv. (Vn.) 

Sulphur: — ldrachm to the ounce in cold cream, al- 
cohol or vaseline, constitutes one of the best remedies 
when pitvriasis or seborrhcea sicca is the cause. 
(B. H.) 

Tr. Capsici, gi— iij to gi ; Chloral, 3— ^i; Tr. Nux 
vom., 3-^i; Hydrarg. Bichlor., 1 to 500, are other 
stimulants in use. (B. H.) 

Many cases do better under an antiparisitic treat- 
ment. Antiparasitic Soaps should also be considered. 

(Pf.) 

Borax: — Is useful for cleansing, but its continuous 
employment is injurious. (Ja.) 

Yolk of Egg beaten up in lime water forms an ex- 
cellent shampoo. Brushing the hair vigorously 
in reverse direction to that in which it lies is bene- 
ficial. (Rd.) 

ALOPECIA AREATA. 

Treatment is regarded b} r some dermatologists as 
ineffectual, either for restoring the growth of hair or 
for preventing the formation of new patches (Ka- 
posi); many writers, on the other hand, while not 
claiming much, advise the persistent employment 



22 DIGEST OF EXTERNAL THERAPEUTICS. 

of remedies. Local treatment should be directed 
toward stimulation of the skin. Before application, 
the scalp should be well washed with Castile soap or 
with spirits of green soap. (Vn.) 
Some of the numerous remedies are as follows : 
Chrysarobin: — 3-12 per cent, ointment (caution 
about getting any into the eyes). (B. H.) Oleate of 
Mercury:— 2-10 per cent. Iodine:— The tincture 
painted on patches, has been followed by growth 
of hair; a 33Mj percent, solution in collodion is also 
used. (Ja.) 

Capsicum and Cantharides: — The following is a 
useful combination : 

Tr. Cantharidis, 

Tr. Capsici, aa £ss. 

Ol. Ricini, 3 SS - 

Aq. Cologn., gi. (Vn.) 

A formula of Tilbury Fox, which Van Harlingen 
says he has used with satisfaction, is : 

Tr. Nucis Vom., ,^ss. 

Tr. Cantharidis, %vi. 

Glycerini, 3"- 

Aq. Destill., 5i ss - 

Aq. Rosae, %\n. 

Carbolic Acid: — A 95 per cent, solution brushed 
lightly with a swab over the affected part and then 
rubbed in is highly recommended by Bulkley. 

Hydrarg. Bichlorid.: — This remedy enters into the 
formation of many lotions ; it may be used in solu- 
tion of 2-3 grains to the ounce, or in combination 
with other drugs. It forms one of the principal in- 
gredients in the method recommended by Raymond 
who promised to restore the hair in sixty days 
by adopting the following: The surface of the de- 



ALOPECIA AREATA. 23 

nuded patch is first washed with carbolic soap, and 
the periphery shaved. This should be done twice a 
week ; then every morning the following wash is 
rubbed in with a paint brush for one or two minutes: 

Hydrarg. bichloridi, gr. viss. 

Tr. Cantharidis, ^vi. 

Bal. Fioravanti, % 5^ ss - 

Aq. Cologniensis, gv. 

At night the following solution is to be used in the 
same way: 



Acid. Salicylici, 


3ss. 


Naphtholi, 


5iiss. 


Acid. Acetici (crystal,) 


3ss. 


01. Ricini, 


§iiiss. (B. H.) 



Subcutaneous administration of the bichloride has 
been successfully employed by Moty ; he used a 4 per 
cent, solution in water, with 2 per cent, of cocaine 
added. Of this a single injection of one drop was 
made in a medium sized patch, and from four to five 
about a large patch, and at its periphery. There 
should be intervals of four days between the injec- 
tions. A cure is said to be expected after the fourth 
series of injections. (Ja.) 

Pilocarpine:— Ointment grs. xv-^i. 

Acetic Acid: — Painted on the spots until they 
whiten, then sponge with cold water ; repeat three 
or four times a day. (Ja.) 

The following was recommended by Sir Erasmus 
Wilson : 



Ol. Amygdalae Dulcis, 




L4q. Ammonise Fort., 


aa §ss. 


01. Limonis, 


5ss 


Spts. Rosmarini, 


ad giv, 



24 DIGEST OF EXTERNAL THERAPEUTICS. 

Also the following applied with friction : 

Tr. Aconiti Rad., ^iv. 

Chloroformi, 5ii- 

Liq. Ammoniae, %i. 

Pulv. Camphorae, ^i. 

01. Olivse, ad gii. (Vn.) 

Cantharidal Collodion : — Blisters are sometimes 
used with success, and are mentioned by many der- 
matologists. Crocker, after blistering recent patches, 
directs that the loose hair about the patches be pulled 
out, and the following ointment rubbed in: 

Chrysarobin., 3 ss ~i- 

Lanolin., ^i. 

Ol. Olivae, q. s. 



ALOPECIA SYPHILITICA. 

As the hair will return under constitutional treat- 
ment local measures, as a rule, are of little import- 
ance ; if their use, however, is deemed expedient, the 
preparations mentioned, in preceding paragraphs 
especiallly those containing Bichloride of Mercury, 
may be employed. 



AMENORRHEA. 

Hot Sitz Baths: — For six days previous to the 
periods or at the time of the period, mustard may be 
added. (R.) 

Cold Sitz Baths: — Of service ; administered as fol- 
lows : Place the patient in a bath tub with water at 
58°, keeping the feet and legs warm and shoulders 



ANAESTHESIA. 25 

covered ; after the bath the patient should be well 
rubbed and placed in bed. These baths should be 
used only in functional varieties. (Ga.) 

Spinal Ice Bag: — Applied to lower dorsal and lum- 
bar vertebrae, are useful in some cases. (R.) 

Hot Water Douches: — Friction along spine. Mass- 
age. (Bt.) 

Electricity: — One of the most reliable emmena- 
gogues. Use either the faradic or galvanic current, 
the former should be tried first. The primary fara- 
dic current is applied as follows : Negative pole in the 
uterus, positive pole externally to abdomen ; seance 
to last fifteen minutes. Galvanism may be used if 
faradism fails. Electricity is especially useful for 
long standing cases which have resisted all other 
treatment ; and in those cases where the parts are 
poorly developed or atrophied from superin volution 
or chronic metritis. (K. C.) 

Gymnastics, Sea Bathing and Saline Spring Baths 
are other serviceable remedial agents. (T. 97.) 

ANESTHESIA. 

Chronic alcoholism, emphysema and fatty degen- 
eration of the heart are peculiarly unfavorable condi- 
tions for the administration of anaesthetics. More 
disasters arise from the latter cause than from any 
other. Tumors and abscess of brain are also danger- 
ous. Very much enlarged tonsils, swollen epiglottis 
and oedema of the glottis, are contra-indications,but 
not insuperable. No operation, however slight, should 
be undertaken until anaesthesia is complete. Enfeebled 
persons often bear anaesthesia better than the ro- 
bust, women and children better than men. It is gen- 



26 DIGEST OF EXTERNAL THERAPEUTICS. 

erally safer when given for an operation in disease 
than for injury. Administration should always be 
on an empty stomach. At first the anaesthesia 
should be given slowly. Before administering, an 
ounce or two of whiskey or brandy is recommended 
by some surgeons. 

• Morphia Subcutaneously is advised by Bernard to 
enable the inhalation to proceed more quietly. Many 
surgeons prefer giving morphia subcutaneously after 
the operation before recovery of consciousness ; this 
is especially desirable in operations in which the 
after effects are painful. The quantity of the anaes- 
thetic required is much less, and the stage of insensi- 
bility more prolonged when the drug is thus given. 
It is also claimed that it has the property of antago- 
nizing the paralyzing action of the anaesthetic on the 
cardiac and respiratory centres and thereby prevents 
shock. (B.) 

Chloroform is attended with more danger than 
ether, but produces less gastric disturbance. It is 
less disagreeable, and not inflammable, and is there- 
fore better adapted for administration at night. Its 
action is also more prompt and the narcosis induced 
by it more sustained, but these advantages are over- 
come by the greater freedom from danger which ether 
possesses. Its use, as a rule, when ether is available 
is not justifiable. It should be preferred, however, 
in obstetrics, because of its prompt action, compara- 
tive agreeableness and non-inflammability. It has 
been shown to be safe in labor when properly admin- 
istered. (B.) The respiration, countenance and 
pulse should always be carefully watched. The well 
known A. C. E. mixture, much used in England, con- 
sists of Alcohol (95 per cent.) 1 part, Chloroform 2 



ANESTHESIA. 27 

parts, Sulphuric Ether 3 parts, made up fresh as re- 
quired. (Ga.) 

Ether should always be preferred as an anaes- 
thetic. Administration should proceed at first 
slowly, and the drug should not be crowded. The 
pulse, temperature and countenance should be care- 
fully watched. A period of eight to twelve hours 
fasting should always precede its use. 

Means for Meeting- Dangerous Symptoms During 
the Administration of Anaesthetics : 

Remove the cone and immediately invert the pa- 
tient according to Nelaton's method ; if respiration 
has stopped, apply artificial respiration by Silvester's 
method, forcibly draw out the tongue; use faradism 
to the respiratory muscles ; apply artificial warmth 
and give amyl nitrate by inhalation. (B.) 

Brandy, whiskey and ether are recommended to be 
given hypodermically, but some observers regard the 
administration of alcohol and its derivatives in this 
condition as not only questionable but productive of 
positive harm. (B.) Inhalation of ammonia are of 
service. 

Nitrous Oxide Gas: — This is a safe agent for short 
operations, quickly executed, such as extraction of 
teeth, opening abscesses, etc. It may also be admin- 
istered with excellent effect preparatory to ether. 
The patient is first placed under the influence of the 
gas, which is then withdrawn, and the ether applied. 
This procedure obviates the unpleasant effects of the 
first inhalations of ether, often less is required, and 
the after effects less disagreeable. For those persons 
who particularly dread taking ether, this is to be 
commended. Experience and care is necessary for 
this method of administration. 



28 DIGEST OF EXTERNAL THERAPEUTICS. 

Local Anaesthesia: — Sprays of Ether, Rhigolene, or 
TEthyl Chloride, for freezing the skin. 

Cocaine: — Solutions of 4—10 per cent, are gener- 
ally successful on mucous surfaces. In minor surgery, 
and in operations where the circulation can be 
arrested, solutions of about 4 per cent., subcutane- 
ously, are of great value. In ophthalmology this 
agent is most satisfactory, being suitable for all op- 
erations on the eyeball, except iridectomy for acute 
glaucoma, and enucleation. In- genito-urinary sur- 
gery it must be used with caution. (M. W.) 

It is also valuable to render painless manipulations 
in laryngological, obstetrical, genito-urinary- and rec- 
tal practice. (B.) 

Tropacocaine: — A costly drug; it causes in the eye 
neither ischaemia, irritation, or hyperaemia ; 3 per 
cent, solutions are employed. Compared to cocaine 
its action is quicker, but more transitory. The 
action must be kept up by adding a drop from time 
to time; mydriasis is slight. It may be employed 
when it is desired to produce anaesthesia without 
dilatation of the pupil. No harmful effects have been 
observed. (M. W.) 

Eucaine Hyderchloride: — Under this name there 
are two salts which are different in composition. 
They are synthetic compounds, allied to cocaine. 
Eucaine Hyderchloride A. is used for general local 
anaesthesia. Eucaine Hyderchloride B. is slower 
in action than cocaine and less active, possessing half 
the strength, but anaesthesia is more prolonged, and 
the heart is not affected, nor the pupils dilated. In 
ophthalmic practice a 5 per cent, solution is effective ; 
for the nose and throat an 8 per cent, solution. 
(M. W.) 



ANESTHESIA. 29 

Holocaine Hydrochloride: — Half the strength of 
cocaine ; as an anaesthetic for operations on the eye, 
it allows more bleeding, but has no effect on the 
pupil. Its action is prompt and lasting without my- 
driasis, or disturbance of accommodation. It is not 
suitable for hypodermic use on account of its toxic 
effects. (M. W) 

Orthoform: — A white crystaline powder, possessing 
both antiseptic and anaesthetic properties. It is em- 
ployed locally, in a saturated solution, in a 10 per 
cent, aqueous solution of the Hydrochloride, in a 10 
-20 per cent, ointment of the same in lanolin, in a 
saturated solution in Collodion, and as a dusting 
powder. It is useful for burns and painful ulcera- 
tions, and appears to be non-poisonous, more than 
700 grains having been used locally on a cancer dur- 
ing the course of a week. (L. II., 97.) As a spray 
for laryngeal and nasal ulceration 5 grains should be 
dissolved in 50 minims each of rectified spirits of 
wine and water ; for insufflation in laryngeal tuber- 
culosis 3 grains may be administered. The drug does 
not produce sufficient anaesthetic effect to permit of 
an operation, though it is said to render painless op- 
erations within the uterus. (B. M. J., I., 98.) (M. 
C, 12, 97.) 

Anaesthesia by Infiltration : — Solutions of Cocaine 
4—5 per cent, are injected along the seat of the in- 
tended incision ; this is not without danger, as the 
drug necessarily enters the circulation. When the 
seat of the incision is so situated the part should be 
ligated and thus cut off the circulaion. The wound 
should be allowed to bleed before the removal of the 
ligature. 

A useful formula is as follows : 



30 DIGEST OF EXTERNAL THERAPEUTICS. 

Cocainae Hydrochlorat. , grs. iiss. 

Morphise Hydrochlorat., * gr. y$. 

Sodii Chlorid., grs. iii. 

Aq. Destill., 3 n i ss - 

The proportion may vary from one-tenth the 
quantity of cocaine to twice as much or more. In- 
jections should be made through the true skin and 
should be numerous enough to produce insensibility 
of the surface. At the points of injection wheals will 
appear. (B.) 

Schleich's Anaesthetic Salts: — The composition of 
these salts to which reference is frequently made is as 
follows: 

According to the Centralblatt fur die gesammte 
Therapie for October, 1897, there are three kinds of 
Schleich's tablets on the market, numbered 1, 2, and 
3, as follows : 

i. Cocaine Hydrochloride, 3 grains. 

Morphine Hydrochloride, 0.675 grain. 

Sterilized Sodium Chloride, 3 grains. 

To be dissolved in 1,500 grains of distilled water. 

2. Cocaine Hydrochloride, 1.50 grain. 

Morphine Hydrochloride, 0.675 grain. 

Sterilized Sodium Chloride, 3 grains. 

To be dissolved in 1,500 grains of distilled water. 

3. Cocaine Hydrochloride, 1.50 grain. 

Morphine Hydrochloride, 0.075 grain. 

Sterilized Sodium Chloride, 3 grains. 

To be dissolved in r,5oo grains of distilled water. 



ANEURISM. 

Rest is imperative and must be absolute. In some 
instances the recumbent posture has a favorable 
effect. (Rd.) 



ANEURISM. 31 

Galvanic Puncture has been successful in a few in- 
stances. Ciniselli reported twenty-three cases with 
five cures. In the small sacculated variety it may be 
employed with some hope. First introduce into the 
sac a needle insulated except at its point, to this the 
positive pole is attached, and the negative to a large 
electrode placed over the abdomen. The current is 
allowed to pass from three to four hours. Before 
operating the apparatus should be tested in fresh 
blood or egg albumen. Danger from embolism ap- 
pears to be slight. (Gn.) Another method is that of 
Loreta; two needles are passed into the sac, and a 
mild current of electricity is passed through, produc- 
ing both an electrical and mechanical effect. (Ty.) 

Ergotin: — Injections of the aqueous extract were 
first employed by Langenbeck ; from 2—5 grains are 
dissolved in water or glycerine and injected into the 
region of the sac; or 7—10 drops of Squibbs' fluid 
extract may be used. The injections should not be 
made more frequently than once in two or three days 
under favorable conditions. (AI.) 

Introduction of Foreign Substances, such as fine 
wire, catgut or horse hair, have been employed, pass- 
age into the sac being effected through a hypodermic 
needle. (Ty.) 

McEwen's Method: — Render the skin aseptic and 
insert a needle into the sac until it comes in contact 
with the other side. The needle may be left in for 
twenty-four to thirty-six hours. Another plan of 
McEwen was to introduce the needle, as just de- 
scribed, then to move it about so that the opposite 
wall of the sac was irritated. The needle was thus 
moved for about ten minutes, then changed to another 
point without withdrawing. In this instance the 



32 DIGEST OF EXTERNAL THERAPEUTICS. 

needle was left in only a few hours. Success has been 
attained by this procedure. (G. A. 0.) 

Compression: — This method has been successfully 
employed in peripheral aneurisms ; digital compres- 
sion is the best plan to be adopted. Relays of students 
or others continuously applying compression, for 
forty-eight hours, have resulted in coagulation and 
cure. (Ty.) 

Injection of Astringents: — Solutions of persulphate 
or chloride of iron or lead acetate are dangerous and 
should not be used. (G. A. 0.) 

Injection of Gelatin: — This method has yielded 
some remarkable results and seems worthy of further 
consideration, but as yet the subject is too recent to 
form a decided opinion as to its value. 

The operative proceeding is as follows : A solution 
of 2 grams of gelatin in 100 grams of saline solution 
is made, this is injected under the skin of the thigh 
into the subcutaneous cellular tissues in a dose of 250 
cu. cm. The injection is renewed at varying intervals 
of time — from every two days to fifteen days. As a 
rule, 10, 15, or 20 injections are quite enough to ob- 
tain a complete cure. Huchard has employed the 
method in many cases, one of which was very serious, 
the pulsation of the aneurism being very strong. A 
complete cure was obtained by means of 20 injec- 
tions. The sole inconvenience attached to this treat- 
ment is that it was very painful. Certain precautions 
have to be observed in this method, for a patient 
under the care of Boisset, in whom injections had been 
made on a small scale, lest the blood should coagulate 
all at once, died very suddenly from embolism. The 
injections must never be made in the neighborhood 
of the aneurismal sac, and still less into the aneuris- 
mal sac itself. (P. M. J., 11, 12, 98.) 



ANGINA PECTORIS. 33 

Morphia, hypodermically, may be required from 
time to time to allay pain. (G. A. 0.) 



ANGINA PECTORIS. 

Morphia, hypodermically, is the most prominent 
remedy ; the dose for adults should not be less than 
}4 gr. (Ty.) It may be effectively combined with 
Atropine, viz: Atropine, yj^ gr.; morphia, Vs gr. 
(An.) 

Ice: — The application of cold in the form of ice bags 
or Leiter's coil to the precordial region often will 
afford prompt relief ; it is more grateful to some pa- 
tients than heat, and generally should be first tried. 
(An.) 

Heat: — Hot fomentations, bran poultices, hot wa- 
ter bags, etc., may be used if cold is not effective. 
(R.) 

Hot Sinapisms: — Applied over the region of the 
heart is a convenient and effective way to employ 
counter-irritation and affords relief. (Ty.) 

Nitro-Glycerine: — 1 percent, solution in 1 minim 
doses hypodermically, frequently repeated if pain 
continues, may be used in cases characterized by high 
arterial tension. (An.) 

Amyl Nitrite: — Inhalations of 3—5 drops on a 
handkerchief affords prompt relief in cases where 
arterial tension is high ; when the vessels are athero- 
matous and heart fatty it must be used with cau- 
tion. (B.) 

Electricity: — Goodno favors galvanism, following 
the advice of Eulenburg, who recommends the appli- 
cation of the anode to the sternum, and the cathode 
4 



34 DIGEST OF EXTERNAL THERAPEUTICS. 

to the lower portion of the cervical region of the 
spine. Faradism is useful in pseudo-angina. (Gn.) 

ANOSMIA. 

Strychnine: -^ - -fa gr., in a neutral medium by in- 
sufflation was employed by Morrell Mackenzie. It 
should be remembered that alkaloids are more readily 
absorbed by the mucous membrane of the nose than 
by that of the stomach. (Al.) 

Electricity: — Galvanism applied daily, using a weak 
current, increasing the strength according to tolera- 
tion. Faradism may also be employed. (Bos.) 

Stimulation by Powerful Odors: — Powerful but 
agreeable and non-irritating odors by olfaction are 
recommended . They should be frequently changed, 
using half a dozen a day, applying first to one nostril 
then to the other. Better results are obtained than 
by strychnine or electricity. (Bos.) 

ANTHRAX. 

(See Malignant Pustule.) , 

ANUS— FISSURE OF. 

Before making any application order enema if the 
bowels have not already moved, and cleanse the 
parts externally with some antiseptic wash. 

Nitrate of Silver: — One of the most effective reme- 
dies, a weak solution of grs. x-xv to ^i will often 
afford relief and should generally be tried first. (Gt.) 

The crayon applied eve^ two or three days will 
sometimes effect a cure, but must be used with cau- 
tion. (K.) Andrews recommends that the part be 



ANUS — FISSURE OF. 35 

first cocainized, then touched with the fused nitrate 
and the following excellent ointment applied : 

Iodof ormis, q{. 

Ung. Belladonnae, gss. 

Acid. Carbolici, grs. x. 

Cosmolini, gss. 

This should be applied thoroughly every day after 
irrigation with antiseptic lotions. The silver in solu- 
tion may be repeated every third day. (Ad.) 

Goulard's Cerate: — Applied on a small pledget of 
lint will often effect a cure. (K.) For diminishing the 
painful sphincter contractions the following oint- 
ment has proved very effective: 

Morphise sulphatis, gr. %. 

Ex. Belladonnae, gr. ss. 

Vaselini, 5*- (Gt. ) 

Apply at once. 

Dusting powders are frequently both stimulating 
and healing, viz.: Calomel, Iodoform, Iodotannin, 
Bismuth, etc.; one of the most useful is thefollowing: 

Hydrargyri Chloridi Mitis, qH. 

Zinci Stearatis cum Bal. Peru., 5 n - 

Sodii Salicylates, 5*- (Gt. ) 

Conium: — For the relief of painful defecation : 

Ext. Conii, £{. 

Ol. Ricini, gss. 

Eanolini, gi. (T. 98.) 

Zinc Oxide-.— 3ss with vaseline %i. (K.) i*Esculus 
Hip. the cerate after movements. Hamamelis: — 
The tinct. si, glycerine sss, for the soreness around 
the parts. Tannin: — ^i to glycerine §iii,. introduced 
on a tent night and morning. (Rd.) 

Ichthyol: — First anaesthetize the part with cocaine, 



36 DIGEST OF EXTERNAL THERAPEUTICS. 

then apply the remedy pure ; repeat the application for 
several days ; on the fifth application the cocaine is 
introduced as far as the internal sphincter, the anus 
slightly dilated with a Nelaton's dilator, and the fis- 
sure more thoroughly touched with the ichthyol. 
For recent cases ten applications will be necessary ; 
for old, twenty may be required. (T. 98.) 

A line of treatment followed, it is said, with some 
success by certain itinerants, is the f olio wing : 

Ext. Hamamelidis, 5 V - 

L,iq. Ferri Subsulphat. , 5^- 

Acid. Carbolici, grs. x. 

Glycerini, qH. 

Mix half a drachm of this with half a drachm of 
starch, and add one and a half ounces of water; in- 
ject this every morning into the bowel. 

The following is recommended to be applied with a 
camel's hairbrush: 

Hydrarg. Bichlorid., gr. i. 

Acid. Carbolic, (crystal), Qii. 

Morph. Hydrochlorat. , grs. v. 

Aq. Destill., 3 iv - 

After application dust with iodoform. An oint- 
ment of Mr. Allingham's is the following : 

Hydrarg. Bichlorid., grs. iv. 

Pulv. Opii, grs. ii. 

Ext. Belladonnse, grs. ii. 

Ung. Sambuci, ji. (Ad.) 

Hydrastis: — The fluid extract applied pure, tends to 
promote healing (B.); also a glycerole of 1 drachm 
of the tincture to glycerine half an ounce; or the 
alkaloid in combination with hamamelis, viz.: 

Hydrastis Mur. , gr. i. 

Tr. Hamamelidis, 5"- 

Aq. Destill., Si. (RcU 



ANUS — FISTULA OF. 37 

Opium, Belladonna, and Stramonium Ointments, 
and lotions of Cocaine form useful palliatives. 

When local remedies, which in many instances are 
only palliatives, have failed, incision or forcible dila- 
tation of sphincter should be employed. 

Incision: — Draw the knife through the ulcer and 
muscular fibres, which can be done with the use of 
cocaine injected beneath the ulcer. It is not neces- 
sary to cut entirely through the sphincter, yet the 
muscular fibres at the base of the ulcer should be cut 
through and the incision made deep enough to pro- 
duce some relaxation of the muscle. (K.) 

Dilatation of the Sphincter: — Thepatient should be 
freely anaesthetized, then the thumbs or index fingers 
are inserted into the bowel and separated in different 
directions, care being exercised not to lacerate the 
mucous membrane ; the anus should be thus stretched 
until it becomes patulous. (Gt.) 

Daily washing the part with cold water and a soft 
sponge and avoidance of all local irritation consti- 
tute the best preventive. The insertion of a piece 
of soft lint, changed daily, is also of service. (K.) 

ANUS— FISTULA OF. 

Some cases will yield to local applications if dili- 
gently and patiently pursued, though the majority, 
especially those of long standing, can only be cured 
by an operation. In recent cases of ischio-rectal ab- 
scess, with external opening and no internal opening, 
the probabilities of success by the use of local remedial 
agents are very good. The patient should be kept in 
bed, the orifice of the abscess enlarged, and free 
drainage established, f olio wed by antiseptic injections 



38 DIGEST OF EXTERNAL THERAPEUTICS. 

of Bichloride of Mercury 1—2000, or some other 
antiseptic. In older cases, when there is a pyogenic 
membrane, more vigorous measures are necessary, 
such as turpentine, iodine, etc. ( K.) 

In children ascarides will often be found to be the 
cause, upon the removal of which union will gener- 
ally take place. (All.) 

Tents of sea tangle may be introduced into the ex- 
ternal orifice of the track for enlarging the opening, 
permitting free drainage and the application of anti- 
septic and other remedial agents. (All.) 

Carbolic Acid: — Applied in the following manner, 
has sometimes been attended with good results. A 
piece of cotton is placed upon the end of a wire, which 
has been roughened in order to retain it; this is 
dipped in a solution of carbolic acid, 9 parts, with 
water 1 part. After thoroughly cleansing, the wire is 
inserted to the bottom of the fistula, which is then 
swabbed with the solution ; a drainage tube is now 
inserted to the bottom of the sinus. If the treatment 
is successful, the tube will be found to require short- 
ening dav by day. The application mav be repeated. 
(All.) 

A method of treatment which is said by Andrews, 
of Chicago, to be that of the so-called " Brinckerhoff 
Cure" is as follows : 

Ext. Destill. Hamamelidis, 5 V - 

Iviq. Ferri Subsulphatis, 5^ 

Acid. Carbolici, grs. ii, 

Glycerini, Qii. 

Inject 10-15 drops deep into the fistula, and press 
around its periphery, so that the fluid will sink in 
more deeply ; then inject equal parts of oil of Euca- 
lyptus, and Glycerine, and keep the patient in bed 
for two days. (Ad.) 



APOPLEXY. 39 

The following will prove of service : 

Hydrastis Mur., gr. i. 

Tr. Hamamelidis, 5^- 

Aq. Destill., gi. (Rd.) 

For stimulating remedies, Kelsey mentions: Sul- 
phate of Copper, Balsam of Peru, Nitrate of Silver, 
Chromic Acid, and Caustic Potash. 

Antiseptic powders and solutions may generally be 
employed for cleansing and dressing, as well as for 
their healing properties. 

Paquelin Cautery: — This agent applied to the 
whole extent of the fistulous tract may be used in 
some cases of the tubercular variety. (K.) 

Operation by the Elastic Ligature is not to be con- 
sidered except when the knife is refused. (K.) 

ANUS— PRURITUS OF. 

(See Pruritus.) 

APOPLEXY. 

During the attack, if possible, convey the patient 
to a large apartment with plenty of cold air, and 
loosen the clothing around the neck. 

Rest: — Should be absolute and the head high, if 
stertor is present the patient should be placed on the 
paralyzed side; the movement of the healthy side will 
will then be free, and the affected side of the cranium 
uppermost, thus doing away with the influence of 
gravity. If there is difficulty in removing the cloth- 
ing, rip up the seams. (Gn.) 

Ice: — Should be applied to the nape of the neck and 



40 DIGEST OF EXTERNAL THERAPEUTICS. 

head when there is no collapse, but cold applications 
are contra-indicated when the face is pale and the 
surface cold. (Ga.) 

Heat and Sinapisms to the extremities and axillae 
are indicated in collapse ; cloths wrung out in hot 
mustard water, and wrapped around the limbs, and 
sinapisms to the nape of the neck should be em- 
ployed, with the hope of bringing about reaction. 

(Go.) 

Dry Cups, Turpentine Stupes, and Sinapisms are 

greatly to be preferred to the old method of cups and 
leeches, which, however, may do good, but only from 
their derivative and counter-irritant effect. (B.) 

Chapman's Spinal Ice Bag: — This is 'an important 
and effective measure, the method of application and 
indications are fully described in the article on Paral- 
ysis. 

" Bleeding the Patient Into His Veins:"— This 
measure was suggested by Dr. Dawbarn, of New 
York, and is described as follows : Apply Esmarch 
bandage, a tourniquet, or Spanish windlass, to one or 
more of the extremities as near the trunk as possible. 
The apparatus should be sufficiently tight to obstruct 
the return flow through the veins quite thoroughly, 
but not so much as to interfere with the arterial 
flow. Experimental evidence shows clearly that this 
procedure lowers arterial tension, and favors cessa- 
tion of internal haemorrhage. The pressure should be 
kept up for about an hour, then the blood should be 
permitted to enter the general circulation very 
slowly. The only objection to this method is that of 
possible danger in the hands of those who are un- 
skilful and lack judgment." (Gn.), 



APPENDICITIS. 41 



APPENDICITIS. 

The following, in conjtmction with internal medi^ 
cation, is advocated by Dr. M. 0. Terry: 

Colon Enemata: — Every three to six hours. In the 
first instance inject 4 ounces of Glycerine, following 
with an injection of Soda Bicarbonate, 1 drachm to 
one quart of water; in subsequent enemata 6-8 
ounces of Sweet Oil are injected after the colon 
enema. The hips of the patient during the adminis- 
tration should be well raised. Hot Fomentations of 
flaxseed are kept applied to the abdomen and hot 
sweet oil is poured over the poultice and applied to 
the abdominal walls. (M. T., 11, 97.) 

Ice applications afford relief and may act as a sub- 
stitute for morphine . ( Ty • ) 

Morphine: — From a surgical standpoint is con- 
demned, pain, it is claimed, being relieved by evacua- 
tions. (Cr.) It is advised by some medical writers 
to be administered hypodermically, but never by the 
mouth. (Ty.) 

Operation: — Dr. G. F. Shrady has summarized the 
indications as follows : 

1. The continuously frequent or progressively ac- 
celerated pulse rate is of itself a prime indication for 
operation. 

2. Pain, localized and progressive, is a valuable as- 
sociated condition. When pain is sudden, severe, and 
progressive, and accompanied with chill, it means 
perforation or abscess rupture and immediate opera- 
tion. 

3. Increase of temperature is third in importance, 
but when associated with one or more of the previ- 



42 DIGEST OF EXTERNAL THERAPEUTICS. 

ous S3 r mptoms, and more especially with increase of 
pulse rate, it makes immediate operation a foregone 
conclusion. 

4. The gradual subsidence of the three cardinal 
symptoms — pulse rate, pain, and temperature — is a 
legitimate reason for postponing immediate opera- 
tive interference. 

5. In cases of abscess it is generally safer, while 
watching for urgent indications, to wait until adhe- 
sions have formed a sufficiently protective wall. 

6. In cases of recovery after mild attacks and with- 
out operation we are never sure of recurrence until 
the latter takes place, when the operation can be 
done soon enough, and, all other circumstances being 
equal, preferably in the interval of a succeeding at- 
tack and when the tissues are not in an inflamed con- 
dition. 

The fact must not be overlooked that there are ex- 
ceptions to all the points named ; that patients with 
a temperature and pulse almost normal and with 
little pain may become rapidly worse and die ; that 
cases which are apparently mild in the beginning may 
develop most alarming symptoms in the end. Few, 
however, present these phenomena without some pre- 
liminary warning. These are irregular cases and 
should always arouse suspicion. (M. R., 9, 1, 97.) 



ARTHRITIS. 

Lithium Carb.: — Garrod has been successful in re- 
moving gouty deposits from the hands and fingers 
by the use of lint soaked in a solution of 5 grains to 
the ounce and kept constantly applied. (Al.) 



ARTHRITIS. 43 

Cold Water Compresses: — Applied to the involved 
joint are often of benefit; a 10 per cent, solution of 
salicylate of soda may be used for wetting the com- 
presses. (Sm.) 

Dry Superheated Air: — The application of dry 
heat at a high temperature has been attended with 
good results. A specially constructed apparatus is 
required for the purpose. (A. S.) 

Cataphoresis: — The following method is of value: 
The positive pole connected with a carbon electrode is 
immersed in a vessel containing a 2 per cent, solu- 
tion of lithium chloride, which*has been rendered al- 
kaline with lithium carbonate ; the negative pole is 
placed in another vessel containing a weak solution 
of chloride of sodium. The part to be treated is im- 
mersed in the lithium carbonate bath, and a conveni- 
ent member, as the hand or foot, is placed in the salt 
solution. The battery should be one of 48 Lechanche 
cells and a current of 10-30 milliamperes should be 
applied for thirty minutes ; some can only stand 10 
milliamperes. Good results have also been obtained 
with salicylic acid and salicylate of soda used in a 
similar manner. (T. 98.) 

Galvanism applied directly to the joints also 
affords relief of the pain. (Gn.) 

Massage: — This is the most efficient measure for the 
reduction of swelling, as it promotes absorption of 
the inflammatory exudates and lessens the rigidity of 
the joints and muscles. (An.) 

The baths of Hot Springs, Virginia, and Arkansas, 
of Richfield, N. Y., St. Catherine, in Canada, Aix les 
Bains, La Bourboule, Royat, Weisbaden, Homburg, 
Gastien, Carlsbad, Wiltbad, Aqui, and Battaglia, in 
Europe are among the most prominent. The selec- 



44 DIGEST OF EXTERNAL THERAPEUTICS. 

tion of one of these springs must depend upon the re- 
quirements of each individual case, for what will suit 
one will not benefit or will positively harm others. 

When trophi burst and form indolent ulcers which 
penetrate to the joint, the most effective way to ob- 
tain resolution is to immerse the part in hot water 
for some hours daily. ^Alb.) 

APHTHA. 

(See Stomatitis.) 

ASCARIDES LUMBRICORDES. 

(Round Worms.) 

These parasites have their seat in the small intes- 
tines, but being liable to migrate they may sometimes 
be reached by the injections used for seat worms. 

ASCARIDES VERMICULARES. 

(Seat Worms.) 

Before using any form of rectal injection for the re- 
moval of these parasites the bowel should be first 
cleansed by an enema of warm water. 

The following injections are recommended: 
Infus. Quassia, one of the most efficacious ; Lime 
Water, simple and satisfactory ; Salt, 3 tablespoon- 
fuls to half a pint of water ; Salicylic Acid and Bi- 
carbonate of Soda, half a drachm of each with 1 pint 
of water. 

ASPERGILLUS. 

Boric Acid: — As a lotion is especially effective after 
bichloride of mercury lotions. ( Al.) 



ASPHYXIA. 45 

Chlorinated Lime: — Grains ii— gi, useful for destruc- 
tion of colonies of these growths in the external 
meatus. (Al.) 

Acid Salicylic:— 2 per cent, in dilute alcohol. (Bn.) 

Chinoline Salicylate and Boric Acid:— 1 part of 
the former to 8-16 of the latter, gives the best re- 
sults, and should be tried first. 

Dr. Hinton recommends the following: 

Iyiq. Plumbi Subacetatis, Mxx. 

Acidi Acet. Dilutis, Mvi. 

L,iq. Opii Sedativi, Mxx. 

Aq. Destillatse.q. s. ad. gi. 
io drops in the ear. 

Alcohol: — Instilled several times a day forms an 
excellent parasiticide; after its use the debris may be 
easily syringed away. (Str.) 



ASPHYXIA. 

The conditions produced by the inhalation of ordi- 
nary illuminating or other poisonous gases, as well 
as asphyxiation by smoke or hanging, are all essen- 
tially the same and require the same treatment. Give 
the patient plenty of air; dash cold water on the face; 
administer inhalations of ammonia and slap the epi- 
gastrium. If these simple measures have no effect, 
immediately employ artificial respiration as subse- 
quently described. 

Asphyxia from Drowning-: — The treatment should 
be carried out at once at the place of rescue, except 
perhaps in extreme weather. Immediately turn the 
patient over with the face downward resting on one 
arm with the wrist under the head in order to cause 



46 DIGEST OF EXTERNAL THERAPEUTICS. 

the water to run out of the mouth and throat. The 
abdomen may rest on a roll of clothing. Run the fin- 
gers into the mouth to clear away any obstruction, 
then with the patient in this position press each side 
of the back over the lungs. This is done to expel any 
water that may be in the upper air passages. Next 
turn the patient on his back, strip to the waist and 
rub dry. These procedures should be executed with 
the utmost rapidity, and during the time the} 7 are 
being carried out, an assistant may apply inhalations 
of ammonia. If these efforts are ineffectual, employ 
artificial respiration by Silvester's or Marshall Hall's 
method. 

Silvester's Method: — Place the patient on his back 
with a cushion or a folded coat under his shoulders. 
Next draw the tip of his tongue forward in order to 
prevent obstruction of the air. The tongue may be 
grasped with a handkerchief or covered with sand or 
earth to prevent slipping ; if alone, tie the tongue 
against the lower teeth by means of a strip of cloth 
or muslin, carrying the ends around the neck and 
tying on one side. Now kneel behind patient and 
grasp both arms half way between the elbow and 
wrist, then draw them gently but steadily upward 
until they meet on the ground above the head. Re- 
tain them in this position two seconds, then bring 
them down gently, thus reversing the movement, and 
press them firmly against the chest walls for about 
three seconds, causing the elbows to meet over the 
epigastrium. This manoeuvre should be executed at 
the rate of fifteen to sixteen times a minute. 

Marshall Hall's Method:— The patient is placed 
flat on his face. Then gentle intermittent pressure is 
made with both hands on the back, the body being 



ASPHYXIA. 47 

turned on the side or a little beyond; then on the face 
and the same pressure continued. The whole body 
should be worked simultaneously, and the move- 
ments made at the rate of fifteen to sixteen per 
minute. 

Michigan Method: — The patient is laid on the face 
and the head upon the arm. Then stand astride the 
body, and grasp it about the shoulders and armpits 
and raise the chest high as you can without lifting 
the head quite off the arm. Hold it in this position 
for about three seconds, then replace the body on the 
ground, and press the lower ribs downward and in- 
ward with a slowly increasing force for three sec- 
onds, then suddenly let go and commence the move- 
ment over again. The Silvester method is generally 
employed in preference to the others. 

The temperature of the bod}' during the process of 
resuscitation should be maintained by hot water 
bottles, hot bricks, flannel, etc. Friction upward 
should also be employed. 

Asphyxia Following Anaesthesia : (See that sub- 
ject.) 

Asphyxia in the New Born: — When labor has been 
long, tedious and difficult, preparations should be 
made beforehand for the reception of a probably as- 
phyxiated child. A table with waterproof sheet and 
receptacles for hot and cold water should be at hand, 
also a soft rubber catheter or some such instrument 
for clearing the throat of mucus. 

(A) Treatment of the first or comparatively milder 
forms: Remove all obstructions from the air passages, 
clearing mucus from the throat and mouth, slap the 
buttocks, irritate the skin with rubbing, and pass be- 
fore nostrils some diffusible stimulant, such as cam- 



48 DIGEST OF EXTERNAL THERAPEUTICS. 

phor spirits, or preparations of ammonia. To re- 
move mucus, pass the finger into the throat or press 
the trachea with the fingers as low down as the bifur- 
cation and gently squeeze it against the larynx, 
this forces the mucus into the pharynx whence by 
blowing into the mouth it can be forced out through 
the nose. If the infant does not now begin to 
breathe, a warm bath should be administered, or al- 
ternate cold and warm baths. 

(B) Treatment of the second or severe form: The 
air passages should of course be cleared of mucus. 
Then artificial respiration should be practiced accord- 
ing to the method of Silvester or according to the 
proceeding of Schultz, which is as follows: Grasp the 
child by the shoulders, placing the index fingers in the 
axillae and the thumbs curved forward over the 
shoulders so as to meet the ends of the fingers ; thus 
the entire weight of the child's body rests upon or 
within a circle made by the thumb and first finger of 
both hands. While the body is thus hanging perpen- 
dicularly, the ribs are lifted out and chest expanded, 
and an artificial respiration produced. The body is 
now swung f orward with some force at arm's length 
until the operator's arms are about on a horizontal 
line. A somewhat abrupt termination of the move- 
ment causes the child's thorax to become stationary, 
while the lower limbs fall forward upon the abdo- 
men ; the abdominal viscera now press against the 
diaphragm and produce expiration, the body is re- 
turned to the first position and the manoeuvre re- 
peated. Seven' to eight seconds are required for each 
movement, which should be repeated eight to ten 
times per minute. After two or three minutes ad- 
minister a warm bath. (Am.) 



ASTHMA. 49 

Blowing into the mouth is another procedure em- 
ployed to inflate the lungs. When this is done cover 
the infant's mouth with a towel and blow in it and 
press the lungs gently. (Am.) 

Asphyxia from Foreign Bodies: — When a foreign 
body in the air passages is the cause, invert the pa- 
tient and forcibly slap him on the back. This proced- 
ure is indicated more especially when the object is 
smooth and round. If this fails laryngotomy or 
tracheotomy should be performed immediately. (P.) 



ASTHMA. 

Treatment of paroxysms will vary widely in differ- 
ent individuals, and not infrequently the patient from 
experience will know the remedies most effective in 
his case. 

Cocaine: — Regarded by some observers as of the 
first importance, should be applied to the nostrils 
with an atomizer or ordinary dropper, and repeated 
every four minutes until relief is obtained. It is 
claimed that on account of the intimate sympathy 
between the nasal and bronchial mucous membranes, 
cocaine thus administered will afford relief. (Bos.) 

Stramonium: — Used by burning the leaves and in- 
haling the smoke, or smoking cigarettes made of the 
leaves, or better yet by placing some of the leaves in 
a pipe and smoking. The drug should be -watched. 
The smoke of about half an ounce of the leaves may 
be used at a sitting. A sensation of heat in the lungs, 
fulness of the head and nausea are indications that 
a maximum impression has been attained. (Al.) 

The following is for a fuming inhalation : 
5 



50 DIGEST OF EXTERNAL THERAPEUTICS. 

Stramonium Leaves, gi. 

Powdered Fennel Fruit, gss. 

Iodide of Potash, . gi. 

Powdered Anise Fruit, 5 SS - 

Black Tea in Powder, §i. 

Nitrate of Potash, %\. (T. 97.) 

Nitrate of Potash: — Avery common and effective 
remedy by inhalation. Saturate a piece of blotting 
paper about five inches square in a strong solution of 
the saltpetre, allow it to dry thoroughly, place it in a 
saucer by the bedside and ignite. Many patients 
will fall asleep amid the fumes. (Al.) 

Pulv. Lobeliae Comp. :— This is prepared as follows : 
Nitrate of potash, boiling distilled water, 240 
parts each ; dissolve and add to lobelia in powder, 
stramonium leaves in powder and black tea in pow- 
der 240 parts each. Mix well, dry, and add oil of 
anise 1 part. The fumes of half a teaspoonful or 
more burnt on a plate may be inhaled six or eight 
times a day, and the bed room fumigated with the 
same. This is said to be an imitation of the well 
known nostrums, Himrod's, Bliss' and the Green 
Mountain Cures. (M. W.) 

Morphia:— Alone, or with atropiain doses of ^4 gr- 
and x^-ogr. respectively, subcutaneously, often relieves, 
acting when all other measures have failed. The 
danger of forming the morphine habit should be 
considered. ( An.) 

Amyl Nitrite: — A few inhalations of from 4—6 
drops will act speedily in a certain proportion of 
cases. (Rd.) 

Ethyl Iodide: — Inhalations give good results ; use 
8—10 drops on a sponge. (T. 96.) 

Chloroform: — Direct inhalations, or tfye fumes 
from some, poured on hot water, will afford quick re- 



ASTHMA. 51 

lief. The danger of the habit should not be forgot- 
ten. ( B.) 

Arsenic: — Formula of Trousseau for arsenical 
cigarettes: 

Arsenite of Potash, grs. xv. 

Distilled Water, §i. 

Unsized paper is thoroughly wet with this solution, 
dried, and cut into twenty equal parts, each of which 
is to be rolled into a cigarette, and two or three 
smoked daily. 

The arsenite of soda may be used under similar 
conditions in the same way, the strength of the solu- 
tion being 1 drachm to 1 ounce of distilled water; 
each cigarette should contain from *4— 1 grain. (B.) 

Pyridine: — Place a saucer containing about a 
drachm of the remedy in a small room or closet 
which can be tightly closed. The patient then enters 
and remains for twenty to thirty minutes ; this can 
be repeated from two to five times a day. In simple 
cases it is claimed a cure may be effected in from ten 
to thirty days. It is said to be useful in asthma from 
any cause. (B.) 

Dilute Hydrocyanic Acid: — 3 drops to half a pint 
of hot water ; inhalations of the vapor will often ar- 
rest paroxysms. This was recommended by Macken- 
zie and others. 

Grindelia Robusta: — A remedy of value. The plant 
should be steeped in a saturated solution of nitre, 
dried, ignited and the fumes inhaled or made into ci- 
garettes and smoked in connection with stramonium 
or tobacco. (B.) 

Methyl Chloride: — Sprays applied rapidly over the 
back of the patient are said to cause an attack to 



52 DIGEST OF EXTERNAL THERAPEUTICS. 

cease in a few minutes. If they are not successful 
light spraying on the upper part of the chest may be 
tried. (Sj.) 

Strychnine: — Subcutaneous injection of a combina- 
tion of the sulphate of strychnine ^ gr. and the sul- 
phate of atropine T ^ gr. repeated daily, have been 
used. (Sj.) 

Belladonna: — In pastels with stramonium, lobelia 
or hyoscyamus. (B.) 

"Cigarettes d'Espic" are said to be made of the 
following ingredients: 

Belladonna leaves, 5^ parts. 

Hyoscyamus leaves, 2.% parts. 

Stramonium leaves, 2}( parts. 

Phellandrium aquaticum, 1 part. 

Extract of Opium, y% part. 

Cherry-laurel water, q. s. 

The dried leaves, stripped of their stems, are cut 
small, well mixed, and then moistened with the opium 
dissolved in the cherry -laurel water. The paper used 
for making the cigarettes is also soaked in an infu- 
sion of these leaves in cherry -laurel water. Usually, 
in making these cigarettes, a little nitrate of potash 
is added to the infusion to make them burn freely. 

" Carton fumigatoire " of the French codex — a very 
useful preparation — is thus made : Take 7 ounces of 
gray unsized paper and 2 ounces of powdered nitre ; 
take of belladonna leaves, stramonium leaves, digi- 
talis leaves, and lobelia leaves, each 75 grains ; take 
of powdered myrrh and powdered oliban, each 150 
grains. Tear the paper in pieces and soak it in water, 
then add the powders previously mixed, and pound 
and beat them all together. Then spread out the 
soft paste in tin moulds, and dry it in a stove. Finally 



BALANO — POSTHITIS. 53 

cut this quantity into thirty-six pieces, each 6 cen- 
timeters long and 4 centimeters wide. One of these 
is burnt in the patient's room. (Y.) 

Galvanism of the pneumogastric and cervical sym- 
pathetic has relieved some cases and entirely failed in 
others. (B.) This, however, may be said for all rem- 
edies recommended for asthma. 

In adopting any of these expedients ventilation 
must not be neglected ; the windows should be regu- 
larly thrown wide open to renew the air of the apart- 
ment. It is well to keep the atmosphere of the room 
moist. (Ga.) 

The shower-bath is a valuable and potent agent to 
fortify the body against asthma ; the sudden applica- 
tion of water strengthens the whole system, and ren- 
ders the body less sensitive to atmospheric changes. 
Out-of-door exercise, as walking or riding, is also 
useful, but it should not be taken until one or two 
hours after a meal, or to such an extent as to occa- 
sion fatigue. (Rd.) 



BALANO— POSTHITIS. 

In mild cases cleanliness with the application of 
some bland powder is usually all that is necessary. 
(T. 97.) 

Tepid Water Injections beneath prepuce fre- 
quently applied (W.), and strips of lint laid between 
the foreskin and the glans removed as they become 
moist, are useful. 

The parts should be bathed every -two to six hours 
with one of the following solutions: 

Carbolic Acid, 1-100. 



54 DIGEST OF EXTERNAL THERAPEUTICS. 

Mercuric Bichloride, 1-5000. 

Boric Acid, saturated solution. 

Succus Calendulse, 10 drops to water 1 oz. 

Aqueous Hydrastis (Ernesty) 10 drops to water 1 
oz. (CI.) 

Alumnol, 1-5 per cent, strongly recommended. 
(Sm.) 

Zinc Sulpho-Carbolate, 1-5 per cent. (H.) 

After cleansing with an antiseptic solution dusting 
powders will be found effective, such as Alum, Tan- 
nin, Bismuth Subnitrate. While using, the parts 
should be kept separated with a piece of lint. (CI.) 

Lead and Opium Wash, continuously applied for 
oedema of the prepuce, is very beneficial. (H.) 

Fid. Ext. Hydrastis, 1 part with dilute alcohol 4 
parts as a lotion. (Sm.) 



BEDSORES. 

Preventives: — The utmost care should be exercised 
to guard against the formation of bedsores. Moist- 
ure being a potent factor in their causation, the pa- 
tient should be kept thoroughly dry and scrupulously 
clean. Pressure upon bony prominences must be re- 
lieved as much as possible with air cushions, and in 
very protracted illnesses air or water beds should be 
used when practicable. The exposed parts should be 
bathed with Castile soap and warm water, then care- 
fully dried with a soft towel. 

The following are recommended for application 
with the view of hardening the skin and preventing 
the formation of sores : 

Olive Oil 3 parts, with 1 part of Laudanum, and 2 



BEDSORES. 55 

of Brandy, was recommended by Florence Nightin- 
gale. Brandy, Proof Spirit or Alcohol diluted. (Bt.) 
Collodion, as a protectve. (N.) 

Alum, used in various ways, the following are ad- 
vised : 

Alumin., 5 SS - 

Albumin. Ovi, iv. 

Tr. Camphori, j$ii. (B.) 

Or: 

Alumin., 

Sod. Chlor., aa ^ss. 

Aq. Destill., 

Alcohol . , aa. Oi . ( Sn . ) 

Ammon. Nitrate: — 5 grains with half an ounce 
each of alcohol and water, diluted with equal parts 
of water was used by Agnew for rubbing on the 
back. (Al.) 

Nitrate of Silver: — Grs. x— ^i painted on when the 
skin is red but not broken, is one of the best preven- 
tives. (F.) 

Other useful preventives are soap plaster re- 
tained in place by adhesive plaster, Decoction of 
Oak Bark, Glycerine, Glycerine Cream, Opium Lin- 
iment, Spirits of Camphor, Hamamelis, Lime 
"Water and Solutions of Gutta Percha. 

When Sores Have Formed antiseptic washes, such 
as the following are called for : 

Hydrarg Bichlorid., 1-3000-5000. 

Boric Acid., saturated solution. 

Hydrogen Peroxide, 1—8 or stronger. 

Creolin, 5-1000. 

Pyoktanin, 1-1000. 

After the application of the selected antiseptic solu - 
tion, one of the following dusting powders may be 



56 DIGEST OF EXTERNAL THERAPEUTICS. 

used: Acetanilid, Airol, Dermatol, Nosophen, Iodo- 
form, or Naphthalin, the latter in the strength of 5 
-10 per cent., the others pure. The same remedies 
may also be used in the form of ointments. 

Calendulated Boric Acid: — Dusted ®ver the sur- 
face, is highly endorsed, being employed with excellent 
results at the Middletown State Hospital for the In- 
sane. 

Calendula: — 1 part of the succus with 4-5 of a 1 
percent, solution of carbolic acid forms a satisfactory 
lotion for the relief of soreness. (M. H.) 

Compound Zinc Stearate with a little Tannin may 
be used with good effect. (Sm.) 



BITES OF INSECTS. 

Liq. Ammon., Ledum or Rhus Tox. of either, 10 
drops of the mother tincture to the ounce of water. 
Lime Water, freshly prepared, a slice of an Onion, 
Moist Clay. (Rd.) 

Cupri Sulphat., grs. v-xv. 

Potass. Bicarbonat., ^i. 

• Aquae, Oi. (Sm.) 

Or 

Collodii, 3 nss - 

Acid. Salicylic, grs. xv. 

Tr. Benzoin., gtt. xv.(T. 97.) 

Camphorated Chloral will quickly arrest pain, and 
is effective for the bites of scorpions. (M. W.) 

Ichthyol: — A 10 per cent, plaster or an ointment 
equal parts with lanolin, or the pure drug in severe 
cases, has been productive of good results. (T. 98.) 



BITES OF SERPENTS. 57 

Potass. Permang: — A 2 per cent, solution sub- 
cutaneously, is the best treatment for stings of bees 
and other poisonous insects. (M. T. 9, 98.) 

Cocaine: — Solutions will relieve the pain. (M. W.) 

Nitric Acid : — May be used when a cauterant effect is 
deemed desirable as in the case of stings by especially 
poisonous insects. (N.) 

The f ollowing is recommended as a preventive : 

Acetic Ether, 5 parts. 

Eucalyptol, io parts. 

Cologne Water, io parts. 

Tr. Pyrethrum, 50 parts. (T. 98.) 



BITES OF SERPENTS. 

Ligation should be applied immediately to the limb 
above the wound, which should be sucked or incised 
and allowed to bleed freely. An attempt should be 
made to express the poison by bandaging the limb 
downwards. When the ligature is removed it should 
be slackened slowly. The Chinese apply as many as 
six tight bands above the wound and generally es- 
cape. (T. 98.) 

Cauterants, such as the Actual Cautery, Nitric 
Acid, Carbolic Acid or Bromine, are generally em- 
ployed after sucking the wound. (Ga.) (B.) 

Potass. Permang: — First apply a ligature, then 
inject subcutaneously a 1 per cent, solution near the 
periphery of the point of penetration of the serpent's 
fang. This is regarded in Brazil as a very effective 
antidote. (Ga.) 

Tr. Iodine: — Painted on the wound until active sup- 
puration takes place, is said to be a trustworthy ap- 
plication for rattle snake bite. (N) 



58 DIGEST OF EXTERNAL THERAPEUTICS. 

Euphobia Prostata:— Used by the Indians and set- 
tlers in Arizona as an infallible remedy against bites 
of poisonotis insects and snakes, especially the rattle 
snake. (N.) 

Aralia Spinosa: — A decoction is used by Southern 
negroes against rattle snake bites. (N.) 

Calmette's Antivenene Serum: — Reports of the 
successful application of this remedy have been re- 
ceived from various sources. Apparently there are 
two factors in snake venom to be dealt w r ith, one 
which acts locally and the other which causes gen- 
eral or constitutional symptoms. These can be sep- 
arated chemically and physiologically, and require 
different antidotes. The poison in the wound may be 
treated by a solution of Hypochlorite of Calcium, 1— 
60, while for the toxine which causes the constituti- 
onal symptoms the antivenene serum should be used. 
A case is reported which was apparently at the point 
of death, where 20 c. c. of Calmette serum injected 
under the skin of the abdomen brought about recov- 
ery. This was administered three hours after being 
bitten ; a second dose of 10 c. c. was given on the sec- 
ond day, this being the full amount. (T. 98.) 

Str> chnine: — Subcutaneously in large doses has 
been successfully used in Australia, and the East 
Indies. It is employed in large doses, carefully watch- 
ing the effects. According to the severity of the con- 
dition, amounts, varying from f to 3—4 grains, 
were given in divided doses in different cases. The 
symptoms were progressively relieved and no toxic 
symptoms from the strychnine were produced. (Sm.) 

Digitalis and alcoholic stimulants, especially whis- 
key, should be administered hypodermically. (B.) 



BLEPHARITIS. 59 

BLADDER— IRRITABILITY AND NEU- 
RALGIA OF. 

Full sized steel sounds passed every fourth day 
have been effective in many cases. (CI.) 

Nitrate of Silver: — Grs. i— ii to ^i, one to three drops 
applied with the Taylor syringe to the prostatic por- 
tion of the urethra, is indicated in some cases. (CI.) 

Aqua-puncture has been successful. (B.) 

BLEPHARITIS. 

Rest and strict cleanliness should be enforced and 
am r errors of refraction corrected. After the removal 
of the scales, which should be done gently, the fol- 
lowing may be used : Hydrarg. Oxid. Flav. — grs. v, 
vaseline ,^i is valuable for destroying any parasite 
which may be present and for keeping the parts clean 
and secretions soft. (Mac.) On account of the fine- 
ness of its particles it is more suitable than the red 
oxide, which may also be used. (N.) 

Formalin: — May be employed in all cases in solu- 
tion of the strength of 1 per cent, to 2 per cent., 
beginning with the weaker. It must be prepared 
fresh, or at the time of using to insure uniformity 
of strength. A small cotton mop is used for daily 
applications. The proportion of cases benefited and 
the measures of relief given, make it a superior 
remedy. (P. M. J., 9, 24, 98.) 

Chloral Hydrate: — 1—10 in solution applied with 
gentle friction is valuable when the scales are difficult 



60 DIGEST OF EXTERNAL THERAPEUTICS. 

to remove. (T. 97.) A weaker solution of 5 grains 
to the ounce is also recommended. (T. 98) 

Ung. Hydrarg. Ammoniat.: — Gr. ss — gi. (N.) 
Tannin: — Grs. v— ^i. (B.) Bismuth Subnitrate: — 
Equal parts with glycerine, in ciliary and granular 
forms. (Wa.) Sulphur and Resorcin: — 2 per cent, 
each, in an ointment for squamous types. Sulphur 
Ointment: — When there is distinct desquamation. 
Pyrogallic Acid: — 5—10 per cent, ointments have 
given good results. (T. 97.) 

Nitrate of Silver: — Grs. x— gi, applied to the roots 
of the hair acts well in some cases, followed after- 
wards with vaseline to neutralize the effects of the 
silver solution. (Ro.) The crayon may be used on 
exposed ulcers followed by mercurial salves. (T. 97.) 

Acetate of Lead: — The following is for application 
to the edges of the lid : 

Neutral Lead Acetate, grs. ii. 

Cocaine Hydrochlorate, grs. iii. 

White Vaseline, grs. xlv. 

Aristol: — Grs. x— gi an effective ointment. (T. 98.) 



BLISTERS. 

For healing the milder forms of burns and erythe- 
ma: 

Cerat. Cetacei. 

Cerat. Plumbi Subacetatis. 

Cerat. Resinae. 

Fid. Ext. Grindeliae Robust., ^ss., Aquae, giv-vi. 

Infus. Sambuci. 

Ung. Cetacei. 

Ung. Zinc. Oxidi. (N.) 



BOILS. 61 



BOILS. 

(Compare Abscess.) 

Hydrarg. Bichlorid.:— Solutions of 1-1000 should 
be used for washing the boil and surrounding parts. 
(B. H.) 

Phenol and Mercurial Plaster: — Render the lesion 
and surrounding surface aseptic with a bichloride 
solution 1—1000, then cover the part with the plas- 
ter, changing daily or oftener. If used before fluctu- 
ation absorption may be expected. The results of 
this treatment are excellent. (T. 97.) Van Hoorn 
recommends that the plaster be changed daily, and 
the patient be ordered to change the underclothing 
frequently. Unna's plaster of carbolic acid and mer- 
cury, is warmly endorsed by Hardaway ; the plaster, 
extending well beyond the lesion, should be used in 
place of a poultice which is condemned by this 
author. A small opening is cut in the centre over the 
conical point of the boil, thus applied, maturation 
will be hastened. (Hd.) 

Iodoform: — When pain is severe, viz: 

Iodoformi, 5^- 

Ung. Vaselini Plumbici, gi. (Hd.) 

Iodine: — The strong tincture frequently painted 
on the part has been used with a view of abort- 
ing ; it is, however, regarded as of doubtful utility. 
B. H.) Jamieson and Haller recommended the fol- 
lowing : 

Tr. Iodi., 5i. 

Acid. Tannici, 5 SS - 

Pulv. Acaciae 3 SS - ( H d.) 



62 DIGEST OF EXTERNAL THERAPEUTICS. 

Carbolic Acid:— This remedy is also employed to 
abort the formation of furuncles ; it is, however, con- 
demned by some observers when used alone for this 
purpose. (B. H.) The following are the methods of 
its application: Inject a 2 per cent, solution, then 
touch the surface with the pure acid and cover the 
part with a carbolized dressing, or heat some of the 
crystallized acid on the point of a probe to the melt- 
ing point and press the same on the surface of the 
furuncle. (Sj.) 

The following is very effective : 

Acid. Carbolici, grs. v-x. 

Ext. Ergote, 3i~ii- 

Pulv. Arnyli, 

Zinc. Oxidi, aa 5"- 
Ung. Aq. Rosse, §ii. 

Take a piece of absorbent cotton several times the 
size of the inflamed surface, and spread the ointment 
on, taking care that no pressure is made to hold 
the plaster in place except at the edges. This will 
afford marked relief, and is used by its author (Bulk- 
ley) for boils in all stages. It should be changed 
every twelve hours. (Bk.) 

Collodion: — At the pustular stage for small boils 
and pimples, used on account of its contractile 
power, is often effectual in arresting development. 

(Al.) 

Resorcin: — A thick layer of the ointment made 
with vaseline has good effect in carbunculous boils. 
(N.) 

Arnica: — The tincture or extract of the flowers 1 
part, and 2 parts of honey, with an inert powder, is 
used with a view of arresting. (N.) 

Nitrate of Silver: — 5—20 grains to 1 ounce of 
nitrous ether, painted on to abort, is specific if ap- 



BOILS. 63 

plied early. *(R.) See also Higginbottom's method 
under abscess. 

Airol: — A 10 per cent, gauze has proved very effec- 
tive. (T. 98.) 

Opium: — The powdered extract mixed to the con- 
sistency of a syrup and applied several times a day. 
(Al.) 

Pyoktanin Blue: — As this agent completely arrests 
the development of the staphylococcus aureus it 
should be an effective application. As a dressing it is 
commonly employed in solutions of 1—2000 to 1—100. 
As an ointment in strength of 2—10 per cent. The 
deep purple stain which it causes on the skin and 
linen, and which constitutes an objection to its use, 
may be removed by dilute hydrochloric or nitric acid, 
alcohol or cologne water. (F.) 

Belladonna: — A plaster is used to subdue inflamma- 
tion or linen soaked in a solution of Atropine, grs. 
iv— §i, with water or glycerine for the relief of pain 
(R.) or the ointment with equal parts of glycerine 
spread on linen. (Al.) 

Poultices: — Hot fomentations, to assist matura- 
tion and allay pain, should generally be applied. 
They may be sprinkled freely with Tr. Belladonnas, 
or Tr. Opii. (W.) 

The following is recommended to be applied to 
the surrounding skin during the course of the boil : 

Acid. Boric, 3*- 

Zinc. Oxid., %{. 

Pulv. Amyli, 5^- 

Vaselini, %\. (Hd.) 



64 DIGEST OF EXTERNAL THERAPEUTICS. 

BOWELS, OBSTRUCTION OF— IN- 
TUSSUSCEPTION — FJECAL 
IMPACTION. 

The radical treatment is abdominal section, but 
inasmuch as non-surgical measures are effective in 
some cases they may be employed first. (Gn.) 

Morphine: — Hypodermically administered is of 
great service for the relief of pain and spasm, render- 
ing the following measures more efficient. (Gn.) 

Gastric Lavage: — Affords great relief to the inces- 
sant vomiting, and is often followed by reduction 
of the displacement ; it may be repeated at intervals 
of six hours. (Gn.) 

High Injections: — If the cause is determined to be 
faecal impaction or ifthe obstruction is in the large in- 
testine, copious injections should be tried, using for 
this purpose a warm saline mixture of olive oil, ad- 
ministered by means of a fountain syringe, while 
the patient is in an inverted position. The abdomen 
should be well kneaded, and the body well shaken. 
The injection should be repeated regularly. (An.) 

Inflation with Hydrogen Gas or Air: — If injections 
fail, two or three gallons of the gas or air may be 
carefully introduced (Senn) from a large rubber bag. 
Thorough manipulation of the abdomen may be 
combined, especially if there is intussusception. In 
this condition inflation, early and perseveringly ap- 
plied, will succeed in the majority of instances. (An.) 
Jonathan Hutchinson recommended inflation by 
warm air or water, administered while the patient 
is in the knee and elbow position, with thorough 



OBSTRUCTION OF BOWELS. 65 

kneading of the abdomen. This method, says 
Goodno, is not without risk of causing perforation 
of the bowels. (Gn.) 

Enemata: — Infus. Lobelia: — Half an ounce to a pint 
of hot water, employed for the relief of obstruction 
arising from intussusception, strangulation and im- 
paction. (F.) 

Infus. Tobacco: — Half a drachm to a pint of hot 
ter, macerate for six hours and filter, inject one-quar- 
ter to one-half the quantity, repeating in half an 
hour, if necessary, carefully watching its effects. 
(Sn.) Tobacco holds a secondary place as an anti- 
spasmodic, and care is necessary to avoid toxic 
effects. 

Effervescent Enemata: — Are prepared as follows: 

Sodii Bicarb., Qii-iii. 

Aquae, ^ vi. 

Inject into the rectum, and immediately follow 
with: 

Pulv. Acid. Tartarici, grs. xxxv-xlviii. 

Aquae, ,^iv. (B.) 

Ox Gall: — Injections are useful for the relief of 
faecal impaction, viz : 

Fellis Bovis Inspissat. , ^iii. 

Glycerini, %i\. 

Acid. Salicylici, grs. xv. 

Aquae, q. s. ad. %vi. 

Use in quantities of one half to two ounces, mixed 
with soap suds. (H. F.) 

In severe cases of tympanitis a trocar may be in- 
serted. (An.) 

Intussusception, or strangulation, if not relieved 
within twent}r-four hours, demands immediate oper- 
ation, longer delav is dangerous. (W.) 
6 



66 DIGEST OF EXTERNAL THERAPEUTICS. 



BRAIN, CONCUSSION OF. 

The symptoms of concussion are those of shock 
with the cerebral symptoms in addition. No treat- 
ment is called for in the early stages, unless the col- 
lapse is very alarming, when stimulants will be nec- 
essary, but they are not indicated in cases of average 
severity. The tendency to death in pure concussion 
is from syncope and shock causing failure of the 
heart action. The administration of stimulants in 
these conditions must be such as will be least liable 
to provoke inflammation. 

The patient should be placed in a warm bed with 
the head at first moderately low. Heat should be 
applied to the axillae and extremities. Absolute 
quiet must be enjoined and no attempt should be 
made to arouse to consciousness, nor food or drink 
administered. If depression be prolonged mild stim- 
ulants, such as ammonia, will be called for, and in ex- 
treme cases stimulating enemata may avert impend- 
ing death. Great firmness is often necessary to with- 
stand the urgent demands of friends for expectant 
measures. When reaction appears the head and 
shoulders should be raised a little and cold applica- 
tions and evaporating lotions applied. The apart- 
ment of the patient should be cool and carefully 
guarded from noise and the light modified. Conver- 
sation around or near him must be avoided. After 
recovery he must be kept under observation for two 
or three weeks lest some insidious inflammation de- 
velop. (Rd.) 



BREASTS. 67 



BREASTS, SWOLLEN AND PAINFUL, 
INFLAMMATION OF. 

Collodion: — An application covering the entire 
breast, will often relieve congestion and prevent sup- 
puration. (F.) 

Camphorated Oil or Camphor and Lard: — ^i-^i, 
rubbed in gently will sometimes abort suppuration. 
(Bt.) 

Roller Bandage: — Snugly applied around the body 
so as to give firm support, will arrest the formation 
of an abscess. It should be reapplied daily. (Ga.) 

Massage and Evacuation: — Rub gently in the direc- 
tion of the nipple, and evacuate with breast-pump. 

(Sj.) 

Olive Oil: — As soon as hardness appears rub with 
the oil from circumference to centre, and support the 
breast with a sling made of a broad handkerchief. 
(Ga.) 

Belladonna Ointment: — Applied on lint and cov- 
ered with linseed meal poultices, if used as soon as an 
inflammatory blush appears, will, as a rule, cause all 
traces of inflammation to disappear in twenty -four 
hours. (T. 97.) 

Stramonium: — The leaves as a fomentation are 
effective as an anodyne for engorged breasts. (Sn.) 

Phytolacca Dec: — The tincture sprinkled on hot 
flannels (Ga.), or the following ointment : 

Pulv. Phytolacca^ Rad., 3*- 

Camphorae, ■ grs. x. 

Ext. Belladonnas, 3*- 

Ung. Zinc. Oxidi Benzoat., %i. (Sm.) 



68 DIGEST OF EXTERNAL THERAPEUTICS. 

Phosphated Oil:— Applied with cloths, and gently 
rubbed in. Ammon. Carb., gi-Oi, compresses well 
saturated with the solution, if applied early, will 
prove very satisfactory. Chloroform and Glycer- 
ine, equal parts. Castor Oil and Glycerine equal 
parts; very soothing. Ext. Hamamelidis, Applied 
on lint. (Bt.) 

Spts. Vini Rect.: — When the skin is tense and hard, 
and the veins distended, sponge the parts until quite 
cold, repeating as soon as heat returns. A few spong- 
ings will afford relief. (Rd.) 

Heat: — Applied by means of a bowl lined with flan 
nel saturated with hot water and placed over the 
breast, is one of the most effective means of reliev- 
ing pain and preventing suppuration. (Rd.) 

These lotions are used : Aconitine, Atropine, Pilo- 
carpine, each in the proportion of 1 grain to the 
ounce. (Bt.) 

When pus has formed it must be evacuated under 
strict antisepsis. The part must be washed with a 
solution of bichloride and an incision made radiating 
from the nipple. A director should be inserted, and 
any pockets of pus searched out and the walls 
broken through. After evacuation the abscess cavity 
may be irrigated with an antiseptic solution, such as 
Creolin 2 per cent., or Hydrogen Peroxide pure, or a 
weak solution of Bichloride of Mercury. After irri- 
gation aseptic gauze with gentle pressure should be 
applied. (Am.) 

Strapping: — Equal pressure applied by means of 
straps of adhesive plaster will prove of great benefit 
in old cases. If there are sinuses first inject them with 
an antiseptic solution. 

Ammon. Chlorid: — 1 ounce, with spts. of rosemary 






BREATH, OFFENSIVE. 69 

1 pint, kept constantly applied by means of com- 
presses, is useful for the induration following sup- 
purative mastitis. (Al.) 



BREATH, OFFENSIVE. 

The condition of the teeth, stomach, mucous mem- 
brane of the throat, nose, and lungs should receive 
attention. 

The following used as mouth washes are of service 
(B.) (N.) (Sm.): 

Hydrogen Peroxide, 1—7 or 8 of water. 

Tr. Myrrh, ,^i to water ^iii. 

Potass. Chlorate, si to water ^iv. 

Potass. Permang: — Gr. i to Rose Water. 



Calc. Chlorinat., 


5iii. 


Aquae, 


Sii- 


Alcohol., 


5". 


01. Rosae, 


gtts. ii. 


One teaspoonful in a glass of water. 




Sod. Biborat., 


3i- 


Tr. Myrrhae, 


gss. 


Glycerini, 


Si- 


Aquai, 


Siv. 


Acid. Tannici, 


grs. iv. 


Acid. Benzoici, 


grs. xlv. 


Tr. Eucalypti, 


3ss. 


Alcohol. (Absolute), 


giii. 


01. Gaulther., 


gtts. XXV 



One to two teaspoonfuls in half a glass of water. (SnO 

Solutions of Boric or Salicylic Acid, Charcoal, 
Camphor and Naphthol are also used. 



70 DIGEST OF EXTERNAL THERAPEUTICS. 



BROMIDROSIS AND HYPERHIDROSIS. 

In the former, frequent ablutions are necessary ; in 
the latter wash as little as is compatible with clean- 
liness. Applications are made in the form of pow- 
ders, lotions and ointments ; as a rule powders are 
preferable. 

Powders. 

Aristcl: — Will restrain profuse perspiration either 
alone or in combination with boric acid or impure 
Zinc carbonate. (Sm.) 

Boric Acid: — For the feet; soak the stockings in a 
saturated solution, allow them to dry, then wear 
thus impregnated with the acid. (F.) 

Chloral Hydrate, gi, starch, ^i, one of the best 
powders. (Vn.) 

Calc. Chlorid., 

Calc. Praeparatse, 

Pulv. Amyli, equal parts. (Sm.) 

[i Naphthol, grs. xv, with Bismuth §i or B i with 
Boric Acid ^ss. (Sm.) 

Dermatol, 20 parts. 

Starch, 10 parts 

Talci, 70 parts. (Sm. ) 

Salicylic Acid: — The fine powder, dusted over the 
feet and stockings, is very effective (B.); also the fol- 
lowing combination : 

Pulv. Acid. Salicylic. 

Pulv. Zinc. Carbonat. Prsecipit. 

Pulv. Magnesii Ust. , aa 5iv. 

Pulv. Amyli, 3 XV - 

Pulv. Talci, 5 XX - ( Vn -)> 



BROMIDROSIS AND HYPERHIDROSIS. 71 

Or, 

Acid. Tannici, 3*- 

Ivycopodii, gi. (Sm.) 

Tartaric Acid: — Has proved efficacious in the treat- 
ment of fetid sweating of the feet. A pinch of the 
powdered acid is dusted every day in the socks and 
between the toes, and the erosions which may exist 
in these places are covered with small pieces of cotton 
charged with boric acid ointment. (Rr.) 

Lotions. 

Alum, 31-ii., Water, Oj. (Sh.) 

Alcohol and Boroglyceride (50 per cent.), equal 
parts. (Sm.) 
Boric Acid (Saturated Solution). (Ja.) 
Hydrastine Muriat., grs. ii-vi., water, ,^i. (F.) 
Salicylic Acid, 3 per cent, solution. (Ja.) 
Chromic Acid: — A 5—10 per cent, solution applied 
once or twice in from two to four weeks is effective 
in bromidrosis of the feet. The same solution is rec- 
ommended by Prof. Richter, viz: Applications 
made every five days to the palms of the hands and 
to the inter-digital surfaces, taking care each time to 
allow the painted parts to dry thoroughly. The yel- 
low color of the skin disappears by washing a few 
times, without ill effects of any kind. Any existing 
fissures ought to be cured, by applications of a 10 
per cent, salicylated soap plaster for instance before 
beginning the treatment of the hyperhidrosis itself. 
Ten applications of the chromic acid solution are 
generally sufficient to effect a cure. 

Sulphate of Copper, gr. i, with Hamamelis, §i. 
(Sm.) 
Naphthol: — 5 per cent, solution in alcohol for bath- 



72 DIGEST OF EXTERNAL THERAPEUTICS. 

ing the parts, or the powder of 1 per cent, with 
starch. (Kap.) 

Hydrarg. Bichlorid., grs. x, Cologne water or tinc- 
ture of Hamamelis, %iv. (Sh.) 

Lead Acetat., 3ii-iii., Water, Oj. (Al.) 

Infus. White Oak Bark. (Kp.) 

Infus. Quillaia:— As a wash for the hands and feet 
once daily. (Sm.) 

Potass. Permang.: — Grs. i-v to water gi, use- 
ful for sponging the feet ; afterwards dust with the 
powder of salicylic acid, and starch. This will often 
correct the condition. (Sm.) 

Zinc: — The oxide, -with starch. (Kp.) The oleate 
grs. iii, starch §ss, or the compound stearate with 
boric acid. (Sm.) 

Ointments. 

These are not as a rule suited for use on the hands 
or feet, powders and lotions being preferable; in 
obstinate cases, however, they may be used with 
benefit. 

Ung. Hydrarg. Oleat.: — 10 per cent., for the axillae, 
the skin being previously washed with alcohol. (N.) 

Alumini Oleat.: — Diluted one-half with lard or 
some other fatty substance, forms the ointment of 
the oleate of aluminum which is very effective. (Sm.) 

Ung. Picis:— Equal parts, with Ung. Sulphur. 
(Vn.) 

Hebra's treatment:— For obstinate and severe forms 
of sweating of the soles of the feet and the hands ; 
take equal parts of olive oil and diachylon ointment, 
melt the ointment, and add the oil, stirring until a 
homogeneous mass results, cut pieces of muslin the 
size of the part, and spread on the ointment thickly, 



BRONCHITIS. 73 

and apply. Lint spread with the ointment should 
also be placed between the toes or fingers and a roller 
bandage firmly applied over all. These dressings 
should be changed twice in twenty-four hours, and 
the parts rubbed dry with lint and starch powder 
without washing. This treatment should be con- 
tinued from one to several weeks, according to the 
severity of the disease. After the discontinuance of 
the ointment the powder should be applied for sev- 
eral weeks. (Vn.) 

Pilocarpine: — Small doses hypodermically have 
proved beneficial. (Sm.) 

Sea Baths or Salt Baths are sometimes of service. 
Carbolic, Juniper Tar, Eucalyptus and Ichthyol 
Soaps. 

Disinfection of the shoes is an indispensable precau- 
tion, to the prevent recurrence of the bromidrosis. 
This is done by pouring a mixture of one tablespoon- 
ful of commercial formalin to one litre of water, or 
a 3 per cent, solution of carbolic acid, into the shoe; 
the liquid is left for a few hours, after which it can be 
dried rapidly. (Br.) 

BRONCHITIS. 

ACUTE BRONCHITIS: 

The patient should be propped well in bed, as posi- 
tion influences stasis of the blood in the lungs. (Rd.) 

Sinapisms, or Turpentine Embrocations: — Applied 
to the anterior surface of the chest will relieve cough 
and oppression. (Ty.) 

Lin. Camphor. Comp.: — Systematically and thor- 
oughly applied with massage, is said to be very help- 



74 DIGEST OF EXTERNAL THERAPEUTICS. 

ful in relieving the sense of constriction and uneasi- 
ness. (T. 97.) 

Vini Ipecac: — Diluted with twice its bulk of water 
sprayed into the throat night and morning for about 
ten minutes, the patient expectorating the liquid as it 
accumulates, is recommended to relieve distressing 
cough, labored breathing and sense of constriction. 
(T. 97.) 

Inhalations of the vapor of a saturated solution of 
Ammon. Chloride or Tr. Benzoin. Comp. poured on 
the surface ol hot water are useful palliatives when 
there is decided oppression. (Ty.) 

Cresolene: — A remedy by this name, sold with a 
small lamp, is extensively advertised and is often a 
very effective palliative ; some of the fluid may be 
poured into a receiver and placed over the lamp, 
the fumes, which are strongly impregnated with car- 
bolic acid, may be inhaled as long as they appear to 
afford relief. 

CAPILLARY BRONCHITIS: 

Counter-irritation by sinapisms, or Turpentine, is 
especially useful. The former may be made with 
about 1 part to 5 or 6 of flaxseed meal, and, if 
the white of one egg and glycerine is used instead of 
water, it may be kept applied much longer. Turpen- 
tine may be applied in the combination known as St. 
John Long Liniment, which consists of a tea cup of 
vinegar and a wineglassful of turpentine beaten up 
with one egg. Rub on the chest and apply with flan- 
nel. This is said to be the most effective way in 
which to apply turpentine. (Ty.) 

Poultices: — These are now generally condemned 
on account of their weight and the exposure in chang- 



BRONCHITIS. 75 

ing. They are, however, recommended by some 
writers for capillary bronchitis in children. 

CHRONIC BRONCHITIS: 

The inhalation of medicated vapors is often em- 
ployed with satisfactory results. The remedies are 
thus used : 

Tr. Benzoin Comp., %i. 

Aq. Bullientis, Oj. 

Inhale vapor night and morning. (Sm. ) 

Acidi. Carbolic, gtts. iii-vi. 

Aq. Bullientis, Oss. (Al. ) 

Iodine: — Combined with turpentine as follows, 
form an excellent mixture, non-irritating to the 
mucous membrane : Iodine 10 parts, alcohol 20 
parts, mix in a flask, and add essence of terebinth 
20 parts, and spirits of lavender 10 parts. Shake the 
mixture well. It will be found useful when expecto- 
ration is profuse and fetid. (Sm.) 

Ethyl Iodide:— 10— 30 minims will afford marked 
relief to the cough, and is the most direct method of 
introducing iodine into the system. (Sm.) 

Terebene: — 5—40 drops to 1 ounce of water with 20 
grains of carbonate of magnesia; a teaspoonful of 
the mixture is added to a pint of water at a temper- 
ature of 140°, and the vapor inhaled for ten minutes 
night and morning. (Al.) 

Turpentine:— 5 minims of the oil to a pint of water 
at 150°. (Al.) 

Creosote: — 5—6 minims with a little carbonate of 
magnesia added to a pint of hot water forms an in- 
halation which is indicated when there is dilatation 
of the bronchi and retention of mucus. (Al.) 



76 DIGEST OF EXTERNAL THERAPEUTICS. 

Sulphurous Acid: — In sprays, or " Pictet Liquid," 
the combination of sulphurous acid and carbonic acid 
gas liquified by pressure of three atmospheres and 
stored in syphons is a very powerful agent and must 
be inhaled with great caution. Carpets, furni- 
ture, hangings, bedding, etc., must be removed and 
nothing left in the room but a chair and a table. The 
slightest pressure on the valve of the syphon will per- 
mit the escape of the gas in minute quantities until 
the desired amount is obtained, the patient being the 
best judge. A peculiar brassy taste with a slight 
sense of constriction of the throat and a little cough 
and feeling of oppression are the effects to be ob- 
tained and kept up for an hour or two. It is claimed 
that if administered with due caution excellent re- 
sults are to be expected. (B.) 

For inhalation when the expectoration is very 
fetid : 

Acid. Carbolici, grs. ii-iv. 

Ol. Eucalypti, M ii-iv. 

Aquae, %i (An) 

To be inhaled from a steam or hand atomizer three or four times 
a day. 

Olive Oil Inunctions to the chest are often soothing 
and strengthening. (Rd.) 



BRONCHIECTASIS. 

Antiseptic sprays and inhalations, as mentioned in 
the previous article and in the articles on Pulmonary 
Tuberculosis, are applicable. 



BUBO. 77 



BUBO. 



Preventive Treatment. 

When suffering from gonorrhoea, chancroid or any 
lesion liable to cause bubo the patient should avoid 
physical exertion as much as possible. 

Cleansing and Dressing of Venereal Ulcerations: — 
All sores should be thoroughly cleansed. As sprays 
penetrate more deeply and irritate less than washes, 
antiseptic lotions are better applied that way. Solu- 
tions of Carbolic Acid 1—100, Hydrogen Peroxide 
half strength, and Nitrate of Silver 1-100 in normal 
saline solutions, are suitable antiseptics. The lesions 
may first be sprayed with the peroxide, then with 
one of the other solutions. 

If there is much secretion Black Wash, or some 
other wet dressing may be applied and renewed after 
each urination. If the discharge is not copious dust- 
ing powders are preferable, viz: Acetanilid, Airol, 
Iodoform, etc. When drainage is impossible on ac- 
count of a contracted and elongated foreskin circum- 
cision should be performed. (T. 97.) 

Abortive Treatment. 

When inflammation has commenced Rest in bed 
and Cold Applications are of great importance. (CI.) 

Collodion: — Painted on the part causes contraction 
and pressure, and is especially serviceable when it is 
impracticable for the patient to remain quiet. (CI.) 

Pressure: — A ball of cotton as large as a man's fist 
is placed over the gland, and bound down by a firmly 
applied spica bandage. A few safety pins are placed 



78 DIGEST OF EXTERNAL THERAPEUTICS. 

in the bandage through the ball to prevent slipping. 
This simple measure is often very successful. (T. 97.) 
Phytolacca Dec.:— The tincture or fid. ext. on cot- 
ton. (Rd.) 

Nitrate of Silver:— A 2 percent, solution injected in 
the early stages. Carbolic Acid:— A 2 percent, solu- 
tion by in j ection . ( F . ) 

The following other measures have been suggested, 
some of which are better adapted to hospital prac- 
tice: 

If the bubo is seen within the first twenty-four or 
forty-eight hours of its becoming painful, the follow- 
ing may be tried to prevent extension : Place the pa- 
tient in bed after a saline purge and apply over the 
bubo a compress consisting of eight or ten layers of 
gauze soaked in dilute solution of acetate of lead, and 
a spica bandage over this. The compress should be 
kept wet with the lead solution for twenty-four hours ; 
if there is no improvement at the end of that time the 
bubo should be dissected out and the incision closed 
without drainage. To accomplish this successfully 
all suppurative lesions of the penis must be thor- 
oughly cleansed and the organ enclosed in an anti- 
septic dressing. The skin over the bubo must be pre- 
pared as if for a major operation. (T. 97.) 

Mercury Benzoate: — Hypodermic injections of this 
salt at one or two points were used for the treatment 
of threatened suppuration in thirty- three cases, thirty 
of which were successful. The amount injected was 
TY2 minims of a fluid composed of a 1 per cent, solu- 
tion of mercury benzoate and a y% per cent, solution 
of sodium chloride. It is claimed that any mercurial 
salt would accomplish the same purpose. The sodium 
chloride is necessary for the solution of the benzoate 
of mercury. (Sm.) 



BUBO. 79 

When Suppurating: 

The following Method of Fontau is recommended 
as most effective for suppurating bubos, reports of 
which give very favorable results. This is described 
by Otis as follows : The skin for some eight or ten 
inches about the part is scrubbed with green soap, 
washed with ether, and then with bichloride 1—1000. 
A narrow bistoury is then inserted into the abscess 
cavity, the contents of which are gently expressed. 
The cavity is then irrigated with the bichloride 1- 
1000, and at once filled to moderate distension with 
warm iodoform ointment (10 per cent, iodoform, 90 
per cent, vaseline). Caution should be exercised 
not to use too much heat in warming the oint- 
ment lest the iodine be liberated. An ordinary cone 
pointed glass syringe may be used for the intro- 
duction of the ointment; the plunger is removed 
and the barrel warmed and filled by means of a 
spatula. Immediately on withdrawing the syringe 
a compress wet with a cold bichloride solution is 
applied and the melted ointment instantly solidifies 
at the orifice and its escape is prevented from the 
cavity. A large compress of sterilized gauze is then 
applied by means of a firm spica bandage. The pa- 
tient should report at the end of four days, when, if 
all is well, the dressing is reapplied, but if there is any 
evidence of inflammation the wound is thoroughly 
irrigated, cleansed and the injection repeated. The 
advantages of this procedure are: 1. Simplicity and 
safety; 2. Rapid cure; 3. The patient can go about 
when under treatment ; 4. The first gland being ren- 
dered aseptic others are less likely to become affected ; 
5. No scar; 6. Does not interfere with another surgical 
procedure should any be necessary subsequently. 



80 DIGEST OF EXTERNAL THERAPEUTICS. 

The method is only applicable when there is infection 
by the staphylococcus and when there is an apprecia- 
ble pus cavity. In diffuse phlegmon with no pus cav- 
ity the treatment has not been found available. (J. 
C. G., 5, 93.) 

Excision: — The following plan has been employed 
with success : The overlying skin is prepared in the 
usual manner as for a capital operation. The in- 
flamed gland is cut down upon, dissected out and re- 
moved and all the surroundng necrotic tissue must be 
removed by a sharp curette, the removal of this tis- 
sue must be as thorough as possible. The cavity is 
then irrigated w T ith hot sterilized water and packed 
for a few moments with hot moist sterile gauze to 
remove loose debris and check oozing. All sus- 
piciously necrotic looking skin is removed ; the gauze 
pack is then taken out and the whole cavity is packed 
full with powdered boric acid ; the incision is then 
closed with interrupted sutures. No drainage is re- 
quired except in neglected cases. When the cavity is 
the size of a duck's egg,the surface about the incision 
is dusted with boric acid and very firm pressure ap- 
plied by means of .a well-adjusted compress of steril- 
ized gauze; over this a spica. Cure may be expected 
in from four to eleven days. (T. 97.) Another 
method of treatment consists in incisions as described 
in the treatment of Fontau, and the introduction of 
a piece of Carbolized or Iodoform Gauze through the 
incision, and allowing the pus to drain off. If after 
evacuation the skin over the cavity becomes sunken 
and shriveled it should be removed and the bubo 
treated like an ulcer as the conditions indicate. (CI.) 

Xeroform: — After a preliminary cauterization with 
carbolic acid, applied as a powder will promote heal- 
ing, and lessen suppuration. (F.) 



BUNION. 81 

Silica Hydrate: — Pack the bubo with the remedy, 
renewing it once or twice a day. It will check sup- 
puration very quickly, but should not be used too 
long as it devitalizes the tissues, and leads to exten- 
sive sloughing. (F.) 

Ammon. Chloride: — 3ii— ^i in hot water useful for 
indolent types. (Al.) 

Sanoform: — Less effective than iodoform but gives 
good results when used as a substitute. It has the 
advantage of being free from odor. (F.) 

Nitrate of Silver: — The crayon lightly applied to 
the surface of indolent bubos and to the cavities of 
sinuses is useful for stimulation. A solution of 31— ^i 
followed by iodoform gauze packing may be em- 
ployed for the same purpose. (Al.) 

Hot Fomentations: — When suppuration is inevita- 
ble, to hasten maturation. (CI.) 



BUNION. 

In recent cases, the sac being thin, it may be 
ruptured by pressure, the contents evacuated and the 
condition corrected. In time the cyst becomes thick- 
ened and this proceeding will be no longer effective. 
In this case the direction of the toe must be changed 
by wearing properly shaped boots made with the in- 
ner side of the sole straight from the toe to the heel. 
(Rd.) 

If the bunion is discharging use stimulating appli- 
cations ; if there is inflammation, poultices and sooth- 
ing remedies. 

Warm Foot Baths: — Very serviceable for the relief 

of irritation of the part. (Rd.) 

7 



82 DIGEST OF EXTERNAL THERAPEUTICS. 

Lotions of Tr. Arnica, gtts. xx— §ss, or Tr. Ruta, 
(mother tincture) same strength when there is any 
tendency to erysipelas, after foot-baths. (Rd.) 
Verat. Vir.: — Equal parts of the tincture with spirits 
of wine and water when there is much inflammation. 
(C.) Copper Oleate: — A 10—20 per cent, ointment 
spread on as a plaster will often relieve. (Sm.) 

Calendula: — 1 part of the succus to 10 of water 
when suppurating. Tr. Iodine and Tr. Belladonna, 
equal parts, apply twice daily. 

Poultices are indicated when pus has formed. (Rd.) 



BURNS AND SCALDS. 

Whatever form of dressing is employed any degree 
of pressure to the burned surfaces must be avoided. 
If the posterior surfaces of the body or limbs are in- 
volved the patient must lie prone. (W.) 

Carbolic Acid: — This is one of the first remedies ; it 
is used mixed with olive oil. A piece of lint being 
soaked in the carbolized oil is applied directly to the 
wound. It is recommended in the proportion of 1 
part of the acid to 50 of olive oil (W.) and in much 
stronger mixtures, such as 1 part to 12. (Ga.) The 
following are useful formulae for its adaptation : 

Acid. Carbolici, 5i ss - 

Glycerini, §ss. 

Aq. Destill., Ad. gvi. (Rd.) 

Or, 

Acid. Carbolici, grs. viii. 

Vaselini, %H, 

Spread on lint. (Bellevue Hospital. ) 



BURNS AND SCALDS. 83 

Acid. Carbolici, grs. xv. 

Liq. Calcis, 

01. Lini, aa gii. 

Wring out cloths saturated in the mixture and apply. (City 
Hospital. ) 

Picric Acid: — A simple and satisfactory remedy for 
superficial burns and scalds. A solution is made as 
follows: Picric Acid, giss., alcohol, ^iii; allow the 
acid to dissolve, then add two pints of distilled wa- 
ter. The burned surfaces should be cleansed with ab- 
sorbent cotton dipped in the solution and the blisters 
pricked ; care should be taken not to destroy the epi- 
thelial surfaces ; strips of sterilized gauze are soaked 
in the solution and applied so as to cover the entire 
injured surface, and the whole kept in place by a 
bandage. The dressing, which soon dries, is left in 
place for three or four days ; it is then removed by 
saturating with the picric acid solution. The second 
dressing is applied as the first and left on for a week. 
The advantages of this treatment are that it seems to 
relieve the pain, and limits the tendency to suppura- 
tion by coagulating the albuminous exudations. 
Healing takes place under a scab, and a smoother 
and more supple cicatrix results than by other 
methods. (T. 97.) Solution of other strengths are 
also employed, as 1—200, which is described as anti- 
septic, analgesic and keratogenous, and free from ac- 
cidents provoked by other antiseptics. Saturated 
solutions are also recommended. (Sj.) 

Carbonate of Lead: — Used either pure or worked 
up with oil to the consistency of cream; it should not, 
however, be applied to large surfaces for fear of toxic 
effects. This remedy was favorably regarded by the 
late Dr. Gross. (Al.) 



84 DIGEST OF EXTERNAL THERAPEUTICS. 

Sodium Carbonate: — Saturated solutions for the 
relief of pain. (B.) 

Carron Oil: — Made by mixing equal parts of lime 
water and linseed oil is an old and well-tried remedy ; 
it was used carbolized by Dr. Gross. (T. 96) 

Flour: — Dusted on thickly, or flour and lard worked 
up together (Ga.) 

Airol: — A dusting powder rapid in effect and unirri- 

tating. (Sj.) 

Guaiacol: — Interstitial injections of a 1—10 or a 

1—20 solution, a Pravaz syringeful, affords relief. 

The action is slower, but more lasting than that of 

cocaine. (Sj.) 

Nutgalls: — 1 part of the powder and 8 parts of 
borated vaseline for diminishing over-abundant sup- 
puration, and as a deodorant. (Sj.) 

Thiol: — An excellent remedy in burns of all degrees ; 
it is employed with occlusive dressings. After dust- 
ing with boric acid the entire surface may be painted 
with a solution of equal parts of thiol and water 
and oiled cotton cloths laid on over the burn. (Sj.) 

For burns of the first degree, the following pow- 
der : 



Zinc Oxide, 


5 parts. 


Magnesium Carbonate, 


io parts. 


Ichthyol, 


i to 2 parts. 


burns of the second degree : 




Zinc Oxide, 


5 parts. 


Prepared Chalk. 


io parts. 


Starch, 


io parts. 


Linseed Oil, 


io parts. 


Lime Water, 


io parts. 


Ichthyol, 


i to 3 parts. 



Both the powders and paste are renewed daily 



BURNS AND SCALDS. 85 

when inflammation is intense the two may be em- 
ployed simultaneously, the burn being covered with 
a layer of the powder, and the paste applied over this. 
(T97.) 

Ichthyol: — In burns of the first and second degree, 
as long as the blisters are small and intact, strong 
solutions have been found of great benefit in relieving 
pain and congestion, and when applied early will 
sometimes even prevent the formation of blisters. If, 
however, the surface is eroded strong solution will 
cause irritation and inflammation. (F.) Equal parts 
with water have been used as soon as the denuded 
skin is removed and some of the inflammation has 
subsided. A 25 per cent, ointment kept continuously 
applied is also employed. (T. 97.) 

Potass. Nitrate: — A few teaspoonfuls in a basin 
of water give excellent results in the treatment of 
burns of all degrees. It acts as a refrigerant ; as it 
dissolves it lowers the temperature of the water from 
5° to 9°. If a burned hand or foot is plunged in such 
a solution speedy relief will be obtained. When the 
water becomes warm the pain returns, then more of 
the salt must be added. Baths of this solution may 
be prolonged three to four days. Compresses may 
also be effectively applied. The formation of blisters 
is in a measure prevented, and cicatrization takes 
place rapidly. (T. 97.) 

: Turpentine: — The liniment is an old and well 
known remedy ; it may be applied as soon as possi- 
ble after the accident. The burned surfaces are 
dressed with cotton and gauze saturated with the 
liniment and so applied as to exclude the air, care 
being observed not to include the uninjured skin. 
(Rd.) 



86 DIGEST OF EXTERNAL THERAPEUTICS. 

The injured parts may be brushed with turpentine, 
and an ointment of turpentine and basilicon applied. 
This constitutes one of the most successful methods 
of treatment. (F.) 

Creolin: — Gauze soaked in a 2 per cent, solution. 
(Sj.) 

Eucalyptus Oil:— 3ss— j-^i of cosmoline. (Al.) Di- 
aphthorin: — %— 1 per cent, solution. (Sm.) Chloral 
Hydrate: — 5 per cent, solution, antiseptic and seda- 
tive. (Al.) 

Aristol: — Valuable; quickly relieves pain. (Sj.) 
This substance tends to form a thick crust over an 
ulcerating surface, and should therefore be watched 
lest secretions and discharges be retained. It is bet- 
ter suited to superficial lesions. 

Lanolin, i part. 

Lard, 2 parts. 

Lime Water, 3 parts. 

(M. R., 3) io, '96.) 

Continuous Warm Bath: — This is advised by Hebra 
in cases of extensive burns. He employed a bath-tub 
six feet long and three feet broad, in the interior of 
which an iron frame was fitted, and transverse bands 
of webbing were attached to the frame as in an ordi- 
nary bed. The frame was suspended in the bath by 
cords attached to each end ; it was provided with a 
pillow and covered with a blanket ; at the head of 
the tub, but at a higher level, was a copper boiler fur- 
nishing water at any desired temperature. This was 
connected with the tub by a pipe which entered at the 
bottom ; through this the water flowed continuously, 
escaping by a pipe at the water level. Thus a con- 
stant flow was maintained. The temperature of the 
water was kept at 90° to 100°, and entirely changed 



BURNS AND SCALDS. 87 

everA' day. A wooden frame, over which a blanket 
was spread was placed over the tub while the patient 
was in the bath. Hebra kept his patients in the 
baths without interruption for as long as one hun- 
dred days. (F.) 

When suppuration commences, strict cleanliness and 
antisepsis must be rigidly enforced. The dressings 
must be changed as often as the condition of the ul- 
cerating surfaces and the rise of the temperature in- 
dicate. Little balls of absorbent cotton, soaked in a 
solution of Corrosive sublimate 1—3000, should be 
used for cleansing. (W.) 

Chloroform: — In severe cases the administration of 
this anaesthetic is advised at the time of dressing not 
only to avoid pain but to lessen shock. (T. 97.) 

In the stage of granulation the following: 

Balsam Oil: — This remedy, introduced by the late 
Dr. W. W. Van Arsdale in 1893, forms an excellent 
dressing for all kinds of granulating wounds, includ- 
ing burns, sloughing wounds and incised accumula- 
tion of pus. It is prepared by mixing 20 minims of 
the balsam of Peru with 1 ounce of cold pressed cas- 
tor oil. For ordinary use a gauze pad may be cov- 
ered with the oil, which can be distributed by using a 
paint brush; sufficient gauze should be used to absorb 
all the expected secretions, especially if the dressing is 
to remain on for three or four days. The whole 
dressing must be covered with oiled silk or rubber 
tissue ample enough to overlap half an inch on all 
sides. Layers of cotton should be applied to lend sup- 
port and the whole retained in place by a bandage. 
(N.Y. M. J., 29, 7, 93.) 

Thymol:— In the strength of 1—3000, has been 
added to ointments, such as those of boric acid 



88 DIGEST OF EXTERNAL THERAPEUTICS. 

or zinc oxide. It is claimed under its influence sloughs 
separate sooner, healthy granulations are formed 
and cicatrization is hastened. The scars are less ir- 
ritable than when carbolic acid is used. (Al.) 

Boric Acid: — A very useful dressing employed in 
various strengths both in solution and in ointment. 
A method of its use is as follows: Apiece of oiled silk, 
dipped in a saturated solution, is applied, then a 
piece of lint of a somewhat larger size also dipped in 
the solution is placed over the silk and held in place 
by a bandage. This was the method of Lister. A 
saturated solution is especially recommended for the 
burns from the actual cautery and the acid nitrate of 
mercury. (B.) 

Bismuth Subnitrate: — Mixed with glycerine to the 
consistency of thick cream and spread on lint then 
covered with oiled silk or rubber. (Al.) 

Salol: — In the proportion of 3 parts to 100 of 
lanolin, allays pain and inflammation. (Al.) 

Salicylic Acid: — gi, olive oil ^viii. (B.) 

Iodoform: — Forms a useful dressing in the propor- 
tion of one part to eight of vaseline ; apply on lint 
and cover with rubber protector. (W.) 

Dermatol: — Especially valuable in lesions attended 
with profuse secretion and therefore useful in burns. 
(8m.) 

Copaiba: — Cotton saturated with the balsam is in- 
dicated when the granulations are pale and flat. (Al.) 

Calendula: — The cerate thinned with olive oil, or 
the following : 

Tr. Calendulae, 3i 

Liq. Calcis. 

Ol. Eini, aa gii. (Rd.) 



BURSITIS. 89 

For Burns of a Minor Character. 

Cocaine: — A 4 per cent, ointment, as a protective 
and an anodyne. Being insoluble in fatty substances, 
the cocaine should first Joe dissolved in oleic acid and 
afterwards added to the ointment base in small 
quantities. (Al.) 

Flexible Collodion: — Greatly benefits burns of the 
first degree by preventing contact with the air. 

Sodium Bicarbonate, with Cosmoline, 1 drachm to 
the ounce. White of Egg mixed with Hamamelis 
Oil, 15-20 parts to the ounce. Liquid Gutta Percha, 
Glycerite of Starch, Rose Water Ointment, Molas- 
ses. 

Lotions of Tr. Cantharides 1 part to 10 of water, 
or Tr. Urtica Urens 1 part to 4 of water. (C.) 

Burns of the Eyelids. 

For slight burns : — Finely powdered Carron Oil, or 
Bismuth, or Cocaine, in one of the following: 

Cocain. Hydrochlorat. , grs. iii. 

Lanolini, grs. v. 

Vaselini, 

Aq. Destill., aa gi. 

For burns of the second degree : 

Cocain. Hydrochlorat., grs. xxiii. 

Salol., grs. xlv. 

Vaselini, %vi grs. xv. 

Before applying, open blister. (T. 97.) 

BURSITIS. 

Perfect Rest with slight counter-irritation, with 
frequent application of Tr. Iodine or a Blister, will 
remove the swelling in most instances. If the cyst is 



90 DIGEST OE EXTERNAL THERAPEUTICS. 

large with thin walls the fluid may be withdrawn by 
Aspiration, and pressure applied with a rubber band- 
age, but when the walls are thick and there is evi- 
dence of lymph within the cavity, as denoted by a 
crackling sound, the most effective measure is Inci- 
sion, turning out the melon seed bodies or masses of 
lymph, then inserting a drainage tube and applying 
aseptic dressings. When the walls are excessively thick- 
ened Excision will be necessary. (HI.) 



CANCER. 

The following are intended to meet the require- 
ments of the practitioner when an operation is re- 
fused, or to serve as palliatives in non-operative 
cases. The consensus of opinion is for immediate re- 
moval by the knife, not only as soon as diagnosis is 
made, but also in all doubtful cases. 

Ulcerating surfaces should first be made as clean as 
the condition admits by the use of antiseptic solu- 
tions, such as Corrosive Sublimate, Potassium Per- 
manganate or Hydrogen Peroxide; then some local 
remedy for the relief of pain and the destruction of 
fcetor should be applied. With this end in view the 
following are recommended : 

Salicylic Acid: — Injections of 15 minims to 1 
drachm of a 6 per cent, solution, repeated six to 
thirteen times, have been used with great relief. It is 
claimed that this is the best treatment for non-oper- 
ative cases. (Sj.) 

Carbolic Acid: — A mild escharotic applied directly 
to cancerous sores and injected beneath the affected 
part limits and retards the growth. The pure acid is 



CANCER. 91 

used for application to the ulcerating surface and a 5 
per cent, solution for injection. (B.) 

Iodoform: — Applied to the surface acts as an anal- 
gesic and deodorant. It may be combined with 
eucalyptus as follows: 

Iodoformi, 

Ol. Eucalypti, aa 3i. 

Vaselini, 

Paraffini, aa gi. (Al.) 

Lycoperdon: — Remarkable virtue is claimed for this 
drug as a haemostatic, antiseptic and anodyne on 
cancerous ulcers. The powder of the fungus is em- 
ployed. (N.) 

Conium: — A hemlock poultice or lint saturated with 
the succus conii are useful anodynes on ulcerating 
surfaces. (Wa.) 

Stramonium Leaves: — The following effective oint- 
ment is used at the Middlesex Hospital, London : 
Fresh stramonium leaves V2 lb., lard 2 lbs.; mix the 
leaves (bruised) with the lard, heat gently and strain. 
(Sm.) 

Calcium Carbide: — The cavities of the cancer are 
filled with the remedy and ordinary dressings applied. 
The action of the remedy is rapid, producing a burn- 
ing sensation which lasts for an hour or two ; at the 
end of that time pain, fetor and discharge have dis- 
appeared and a clot formed as a barrier to haemor- 
rhage. (F.) 

Alcohol Injections: — 30 parts of absolute alcohol 
are mixed with 70 of water ; injections are made 
around the tumor and infiltrated glands twice a 
week. The quantity injected will vary with the size 
of the tumor, sometimes amounting to 20 Pravaz 
syringefuls. In order to avoid injecting into a blood 



92 DIGEST OF EXTERNAL THERAPEUTICS. 

vessel the needle is inserted deep into the tissues, then 
unfastened from the syringe and left in place ; if blood 
does not issue the injection is made, if it does the nee- 
dle is removed and another locality punctured. Under 
this treatment the tumor diminishes in size and be- 
comes less painful. The injections may occasionally 
cause pain and intoxication. Local or general anaes- 
thesia may be employed. (M. T., 9, 97.) 

Alcohol Compresses:— Have a good effect for ar- 
resting the bloody oozing often observed. (Al.) 

Hydrastine Hydrochlorate: — An ointment of 30 
grains to 1 oz. of ointment base destroys fetor. 

Potass. Chlorate: — In a fine powder is used for 
dusting on malignant ulcerations. (Sm.) 

Pyoktanin Blue: — Used in powders or solutions of 
1 per cent, or in collodion 1—30, the latter is painless, 
easy of application and more active. (Sj.) 

Citric Acid: — A saturated solution subcutaneously 
introduced at any point near the periphery of the 
cancer seems to possess an affinity for diseased 
structures ; indurations are reduced and instant relief 
is said to be obtained from the smarting and ten- 
sion. (Sj.) 

Atropine: — Solutions locally for pain are effective. 
(F-) 

Escharotics. 

The application of these agents is limited to ulcer- 
ating cancers and to the removal of cancerous tumors 
in their earlier stages. The removal of cancers by this 
method is slow, painful and less certain to expose 
healthy tissue than the knife ; nevertheless escharotics 
are sometimes used. Before application, if the skin 
is unbroken, a blister or strong ammonia should be 
applied. 



CANCER. 93 

Zinc Chloride: — One of the best escharotics, has the 
advantage of not poisoning the system and limiting 
its action to the point of contact. The claims for its 
superiority over the knife are unfounded. Its action 
causes intense pain, notwithstanding assertions to 
the contrary. Some of the methods of its use are as 
follows: 

Conquin's Paste, a well known preparation, is 
made in various ways. The U. S. Dispensatory gives 
this formula : 

Zinc. Chlor., 5i- 

Pulv. Amyli (Exsiccat. ), ^\i-iv. 

Aquae, M. xxx. 

Zinc Oxide or Anhydrous Sulphate of Calcium may be substi- 
tuted for the Amyl. ( Al. ) 

Mayet's Paste: — Zinc chloride 8 parts, zinc oxide 
1 part, flour dried at 212° 7 parts, water 1 part ; mix 
the zinc oxide with the flour, dissolve the zinc chloride 
in water and add the mixture of zinc oxide and flour; 
rub the paste in a mortar ten minutes. (N.) 

Method of Maisonneuve : — " Cauterization en 
Fleches." This is applied as follows : The patient is 
narcotized, and if it is thought necessary a knife is 
passed deep into the growth ; arrows of the caustic 
are inserted at several points which are cut close and 
left in. Hypodermics of morphine will to a certain 
extent relieve the pain, which is very severe for some 
hours. The skin will turn a dead white. A poultice 
is now applied and in a few days the mass, it is said, 
"shells out like a billiard ball," exposing a surface 
which, if healthy, will cicatrize, but if not, the treat- 
ment must be repeated. (HI.) 

Potassa Cum Creta: — By mixing with alcohol this 
substance is made into a paste ; it may be rendered 



94 DIGEST OF EXTERNAL THERAPEUTICS. 

nearly painless by the addition of morphine and is 
applied as a plaster; at the end of fifteen minutes the 
skin is carbonized and if retained a slough will be 
formed as thick as the plaster. A clear surface will 
be left which heals rapidly. (Al.) 

Sulphuric Acid: — This agent is regarded as superior 
to other escharotics for the destruction of malignant 
growths. Michel's Paste, sl form of its application, 
is prepared thus : 1 part by weight of some indif- 
ferent excipient and 3 parts of fuming sulphuric 
acid are mixed on a glass slab forming a paste, which 
is applied in the following manner: If the surface is 
unbroken it should first be blistered and the epider- 
mis removed, after which cocaine, not exceeding one 
and a half grains to the ounce is applied, at the same 
time a rrypodermic of morphine is administered. 
After the cocaine has taken effect, the paste is applied 
entirety over the tumor to the depth of about half an 
inch. If these precautions are taken it is claimed 
that no pain is experienced. After the tumor is de- 
stro3^ed the cavity is washed out, filled with asbestos 
and covered with zinc ointment. It usually takes ten 
to twelve days for the eschar to separate; during this 
time the wound should be irrigated daily. The pa- 
tient should be kept on the level, otherwise the acid 
will gravitate to one side and a portion of the tumor 
will escape its action. The surrounding skin should 
be protected by collodion and all oozing of any fluid 
carefully mopped up. (Al.) 

Arsenious Acid: — This agent is better adapted to 
epitheliomatous growths. Its application is painful 
and not without danger. The following are some of 
its preparations as an escharotic : 



CANCER. 95 

" Poudre Caustique de Frere Costne ou de Rousse- 
lot: " 

Acid. Arseniosi, grs. x. 

Hydrarg. Sulphid. Nig., [f)ii. 

Pulv. Carbonis Aniinalis, grs. x. 

The powder is mixed with mucilage at the time of applying. ( Al. ) 

" Februre's Remedy: " 

Acid. Arseniosi, gr. ii. 

Aq. Destill., Oi. 

adde 

Ext. Conii, §i. 

L,iq. Plumbi Subacetat., giii. 

Tr. Opii, 5i. 
With this the cancer is washed every morning. (U. S.) 

"Jusetmond's Arsenical Powder: " 

Antimonii Sulphuret., grs. xvi. 

Acid. Arseniosi, grs. ji. 

Melt in a crucible; when cold, reduce the mass to powder and 
add five parts of Extract of Opium. 

"Manec's Paste:" 

Acid. Arseniosi, grs. xv. 

Hydrarg. Sulphid. Nig., grs. lxxv. 

Spong. Ustse, grs. xxxv. 

This is made into a thick paste with a few drops of water. (Al.) 

Method of Cerny and Trunecek: Arsenious acid 1 
part in 75 each of ethylic alcohol and distilled water, 
paint the growth. In twenty -four hours it will be 
covered with an eschar, which after dairy repetition 
of the painting will come off. (T. 98.) 

Sodium Ethylate: — First cleanse the part withpyro- 
zone and dry thoroughly, then anaesthetize with co- 
caine 10 per cent, solution, and apply the remedy full 
strength by means of a glass rod. This strength is 



96 DIGEST OF EXTERNAL THERAPEUTICS. 

obtained by allowing the crystals to deliquesce. The 
following powder is then dusted thickly over the dis- 
eased surface : 

Acetanilid, 3 1 - 

Aristol, qu 

Boric Acid, 3^- 

Vaseline is then spread on sheet-wadding of suffi- 
cient size to cover the whole surface, over this ab- 
sorbent cotton, and bandage. The patient is seen 
every second day, but only the diseased points are 
touched afterwards. Considerable oedema follows 
the first application, but it soon disappears. The 
etiolate is very painful and cocaine does not always 
relieve. It should be kept in small corked bottles, 
care being taken that it does not touch the cork. 
(T. 98.) 

Alveloz:— This drug has caustic action similar to 
zinc chloride and has been used with asserted success. 
Its application is comparatively painless. The juice 
of the plant is preserved for transportation by the 
addition of salicylic acid. (F.) 

CANCER OF LARYNX: 

Sodium Formate: — Solutions of 5—20 grains to 
the ounce of water or glycerine as a spray or 2 parts 
with 8 of starch as an insufflating powder blown 
only on the ulcerated surface, have proved servicea- 
ble applications. (F.) 

Carbolic Acid:— Add 20-40 drops to a pint of wa- 
ter with a small amount of glycerine, heat to 140° 
and inhale the vapor. (Al.) 

The following are for use with the atomizer : 

Hydrogen Peroxide. 

Pyoktanin, ^ per cent, solution. 



CANCER. 97 

Potass. Permang., 2 per cent, solution. 

Carbolized alkaline sprays as mentioned for ca- 
tarrh and rhinitis. 

Morphine, 2 per cent, solutions. 

Cocaine, 5—10 per cent, solutions ; more effective 
than Morphine. 

Thuja, local applications have relieved. 

CANCER OF THE RECTUM: 

As in cancer of other localities, any treatment other 
than extirpation is simply palliative. Sedatives of 
many kinds may be administered with benefit, and 
when one ceases to be of service another may be 
tried. (Gt.) 

Opium: — In some form this is one of the best reme- 
dies ; in suppositories made with 3 parts of glycerine 
to 1 of gelatine, it acts less like a foreign body and 
melts more readily. Battley 's sedative or black drops 
in starch injections and hypodermics of morphine are 
effective. (Gt.) In administering opium or morphine 
the greatest care should be taken not to give any more 
than absolutely necessary as it must be continued for 
months, and the mental state sometimes caused by it 
is most distressing. 

Pyoktanin: — The following suppository is advised : 

Pyoktanin., gr. I. 

Pulv. Opii, gr. T V 

01. Theobromae, q. s. (T. 96.) 

Arsenite of Copper: — A paste made by mixing the 
remedy with mucilage may be applied to protruding 
cancerous masses, an extremely rare condition. (Gt.) 

CANCER OF THE UTERUS: 

Curettage and the Actual Cautery: — The application 

of these measures followed by antiseptic dressings is 

8 



98 DIGEST OF EXTERNAL THERAPEUTICS. 

an old and effective method which has stood the test 
of time. The patient is anaesthetized and placed in the 
dorsal position, all readily removable tissues are 
gouged out with a large sharp curette under continu- 
ous irrigation. The haemorrhage is stopped by pack- 
ing the cavity with iodoform gauze, leaving it in 
place for a short time, then removing. The interior 
of the excavation is now cauterized with the round 
ball of the Paquelin cautery at a red heat, then irri- 
gated with a solution of boric acid 1-20. Tampons 
saturated in a 50 per cent, solution of zinc chloride 
may also be used after curettage, as described under 
that remedy. (K. C.) 

Alcohol: — When infiltration of the surrounding 
tissues is feared parenchymatous injections of abso- 
lute alcohol may be employed ; 80 minims are admin- 
istered, the injections being made at several points, 
but not puncturing very deeply. Usually after ten to 
fifteen injections the discharge lessens or disappears 
and the patient improves. If the growth is too near 
the peritoneum to permit of this procedure, alcohol in 
the form of baths to the part may be administered 
by means of a tubular speculum. (T. 97.) 

Ferric Chloride: — For haemorrhage saturate two 
or three pieces of lint with the chloride and place them 
in contact with the cervix, then tampon with dry cot- 
ton. To avoid excoriation of the vaginal mucous 
membrane, which occurs unless the chloride is very 
much diluted, add carbonate of soda in the propor- 
tion of 4 grains to the ounce of the chloride. (Al.) 

Steam: — Vaporization of the uterus for cancer of 
the fundus has been employed for its haemostatic, 
anaesthetic and caustic effects. The steam is intro- 
duced by means of a canula attached to a rubber 



CANCER. 99 

tube and applied for one and a half minutes ; it is f ol- 
lowed immediately by a dark colored fluid. (F.) 
Compare vaporization of the uterus, under Chronic 
Endometritis. 

Chromic Acid: — This is used pure and in dilutions. 
An effective method, which is said to be of great ben- 
efit, consists in first irrigating the uterus and va- 
gina with a hot salt solution and then applying 
the acid in the strength of 1 part acid to 3 parts of 
water. Care should be observed not to permit any 
of the caustic to come in contact with the healthy 
tissue, which must be protected by a saturated solu- 
tion of bicarbonate of soda. Tampon with iodoform 
gauze after the application. (F.) 

Ferripyrin: — Being astringent as well as anaes- 
thetic, is applicable for the control of haemorrhage 
and discharge. It may be applied directly to the dis- 
eased surface or mixed with charcoal placed in little 
bags and introduced into the vagina. (T. 97.) 

Pyoktanin: — As a dusting powder with gauze pack- 
ing of the same, has improved the general condition. 
(Sj.) Solutions of 1—300 are injected in the infiltrated 
tissue, a few drops at each point, using about 30 in 
all, at intervals of one or two days ; currettage should 
precede the injections and the dry powder be used in 
theuterus. This will prolong life. (K. C.) Amedicated 
crayon for introduction into the cervical canal may 
be made as follows (T. 98.): 

Pyoktanin Blue, 

Tannin, aa grs. iv. 

Powdered Opium, gr. i. 

Olive Oil, gtts. xv. 

Coca Butter, ^i. 

The crayon may be retained by tampons. 



100 DIGEST OF EXTERNAL THERAPEUTICS. 

Terebene: — Tampons soaked in a solution of 1—16 
of olive oil or used pure act well as antiseptics and 
deodorants. (F.) 

Pepsin: — Good results have followed its applica- 
tion to cancer of the cervix ; much of the neoplastic 
tissue may be destroyed this way. (Sm.) 

Salicylic Acid: — Parenchymatous injection of a 6 
per cent, solution in alcohol has been employed with 
satisfactory results. (Sj.) A tampon thoroughly 
impregnated with the drug may be inserted twice a 
da}^ to correct fcetor, in conjunction with vaginal 
douches of a 3 per cent, solution of creolin. (Al.) 

Zinc Chloride: — This remedy may be employed 
after curettage and the actual cautery. Czerny used 
4 parts of the chloride with 1 of zinc oxide and 3 of 
flour enclosed in gauze secured with a tampon by a 
string attached for easy removal. This was allowed 
to remain about six hours, or less if there seemed any 
risk to the vesical or rectal septum. On its removal, 
iodoform gauze was inserted. (N.) 

Another method after curettage and the actual 
cautery consists in packing the crater of the cancer 
with pledgets of absorbent cotton the size of a wal- 
nut which had been soaked in a 50 per cent, solution 
of the chloride and a non-absorbent cotton tampon 
is applied over these. The zinc chloride produces a 
still further separation of the cancerous tissues, and 
in about a week or ten days the slough may be 
removed. In case there is haemorrhage after the sep- 
aration of the slough the cavity may be packed with 
iodoform gauze. Solutions of bicarbonate of soda 
should be employed to neutralize any of the chloride 
which may come in contact with the vagina. (K. C.) 

Bismuth Subnitrate, mixed with Aristol or Iodo- 



CANCER. 101 

form, may be dusted on the interior of the cavity 
when curettage is not practicable on account of the 
disease being too far advanced. (K. C.) 

Carburet of Lime: — A piece the size of a small wal- 
nut is placed in contact with the diseased part and 
the vagina quickly filled with iodoform gauze, which 
is removed in a few days and an antiseptic douche 
administered. (T. 97.) This remedy has been used in 
France with favorable results. The calcium carb- 
uret decomposes into calcium oxide and acetylene 
gas ; at the end of several days the oxide is easily re- 
moved by an antiseptic douche (corrosive sublimate). 
The diseased part becomes grayish and smooth, and 
the pain and haemorrhage are suppressed. (F.) 

Salol Gauze: — May be used with good effect for 
packing after the curette and cautery. (T. 98.) 

Tampons heavily loaded with equal parts of Ben- 
zoin, Iodoform and Magnesia may be used in place of 
injections. (T. 98.) 

Sodium Chlorate: — This remedy is advised inter- 
nally and locally as a palliative. Locally : 

Sodium. 

Subnitrate of Bismuth, aa ^iiss. 

Iodoform, ^i. 

A small quantity is applied by a tampon to the cervix. 

Strips of sterilized gauze six inches long and two 
wide impregnated with 1 part of iodoform, 20 parts 
of sodium chlorate and 20 parts of glycerine may 
also be used. If symptoms of iodoform poisoning 
appear, tampons of salolized cotton saturated in a 20 
per cent, solution of chlorate of sodium should be sub- 
stituted. Finally a vaginal douche of a quart of ster- 
ilized water holding in solution 150 grains of chlorate 
of sodium should be administered daily. (T. 98.) 



102 DIGEST OF EXTERNAL THERAPEUTICS. 

Nitric Acid: — Recommended as an effective caustic : 
the acid is applied to the whole diseased surface and 
a pad saturated with glycerine placed over it. This 
treatment produces a slight slough and destroys 
many of the sources of haemorrhage. It may be used 
every two or three months. (Al.) 

Hydrastis and Sanguinaria: — For epitheliomatous 
ulcerations of the cervix, equal parts of each in pow- 
der have been employed with good effect. 

For the control of haemorrhage use the following: 
Tr. Iodine (Churchill's), Persulphate of Iron in glyc- 
erine on pledgets of cotton, strong solutions of Alum 
and Packing the Vagina, the latter should be em- 
ployed when the haemorrhage is alarming ; the tam- 
pon should be made of antiseptic cotton with a string 
attached to each to facilitate removal. (Cp.) 

Hot Water Douches: — These are valuable for the 
relief of pain and the control of haemorrhage, but 
especially for cleansing. 

Antiseptic Douches: 

Carbolic Acid, grs. viii. 

Glycerine, ^ viii. 

Ess. Thyme, ^iii. 
A teaspoonful to one or two quarts of water. 

Salicylic Acid"; grs. xv. 

Ess. Geran. Ros., ^i-g rs - xv - 

Alcohol, 90 per cent., ^vi. 

A tablespoonf ul to a pint of water. (T-98. ) 

The following are for vaginal injection in the pro- 
portion of the amount mentioned to one pint of wa- 
ter : 

Acidum Carbolicum, ^ss-i. 
Acidum Gallicum, grs. xx-.^i. 



CANCRUM ORIS. 103 



Acidum Tannicum, grs. xx-31. 
Acidum Salicylicum, ^i. 
Alumin, ^i-iv. 
Aqua Chlorini, ^iv. 
Creosotum, Mx-^ss. 
Cupri Sulphas, grs. x-xxx. 
Ferri Sulphas, grs. xxx. 
Kino, %i. 
Krameria, §ss. 

Liquor Ferri Sulphatis, gii-iv. 
Liquor Plumbi Subacetatis, gi-ii. 
Liquor Sodae Chlorinatae, ,^i. 
Plumbi Acetas, grs. x-xx. 
Potassii Chloras, %i. 
Potassii Permanganas, grs. xx. 
Quercus Alba, gss. 
Sodii Hyposulphis, gi-ii. 
Tr. Ferri Chloridi, 3SS-1. 
Zinci Chloridum, grs. v-vii. 
Zinci Sulphas, 31-ii. (Dn.) 



CANCRUM ORIS. 



Cauterization is indicated first and should be imme- 
diately applied with care and thoroughness to every 
portion of the diseased area. The Paquelin or the 
Electro-cautery are the best methods, as they can be 
more easily controlled. The resulting eschar should 
be dressed with warm boric acid solutions until it 
separates; then with astringent lotions. (Mus.) 

Other energetic caustics are Nitric Acid, Hydro- 
chloric Acid, Bromine, Vienna Paste and Zinc 
Chloride. The after treatment should include direct 



104 DIGEST OF EXTERNAL THERAPEUTICS. 

applications of Iodoform, Pyoktanin Blue, Ichthyol 
and Carbolic Acid. (Gn.) 

Subcutaneous injection of Pyoktanin Blue in a sat- 
urated solution promises much, according to 
Goodno. 

Potass. Permang., 1-100; Formalin, 1—15 or 30; 
Tr. Iodine, Fid. Ext. Eucalyptus, pure or with equal 
parts of glycerine, are recommended for use after 
the removal of the slough. (Jac.) 



CARBUNCLE. 

(Compare Abscess.) 

Carbolic Acid: — This effective remedy is employed 
in several ways. A successful method of its applica- 
tion is as follows (Dr. M. 0. Terry): First, apply sev- 
eral layers of collodion over the carbuncle extending 
beyond the periphery of inflammation, but leaving an 
uncovered area in the centre of about one-quarter of 
an inch. Second, make a small crucial opening. 
Third, inject the following: Crystals of carbolic acid, 
20 grains ; glycerine and water, each 2 drachms. 
The injections should be made with a hypodermic 
syringe to which a lachrymal canula is attached; 
push the canula well toward the periphery, injecting 
a few drops in several directions. Repeat daily if 
necessary. As a rule, not more than five injections 
will be required. Simple dressing of vaseline and cal- 
endula and iodoform may-then be applied: (Hel.) In- 
jections of 5-10 minims of a 2 per cent, solution (F.) 
or 5 drops of the pure acid at each point of the car- 
buncle are said to arrest the development. (T. 97.) 



CARBUNCLE. 105 

Non-Incision Treatment: — The following formula 
Is highly praised by Dr. L. D. Bulkley for carbuncles 
as well as boils : 

Acid. Carbolici, grs. v-x. 

Fid. Ex. Ergotae, 3 i— ii. 

Pulv. Atnyli., 

Zinc. Oxidi, aa 3 ii. 

Ung. Aq. Rosae. 

Spread thickly on lint and apply. It is claimed 
that incision has seldom been necessary with this 
treatment, and that better results are obtained than 
with the knife, except in more malignant cases with 
gangrene. Bulkley adds : " I have applied this treat- 
ment to some large and formidable carbuncles, and 
have always found that the pus would find exit read- 
ily enough and healing progress satisfactorily under 
this dressing. On some occasions febrile and other 
symptoms have seemed to call for more active inter- 
ference with the knife ; but although urged to do it, 
I have adhered to the plan of treatment without 
incision, and have obtained results which have war- 
ranted its continued employment. I am prepared to 
aclmit, however, that possibly from neglect or other 
causes a very large suppurating carbunculous area 
might be formed, which would demand active sur- 
gical procedure. I may add that Sir James Paget 
(Clinical Lecturer and Essayist) strongly discounte- 
nances the practice of incision." (Bk.) 

Excision and Erasion: — This procedure is indicated 
when it is not possible to isolate the disease from the 
surrounding tissues. Remove as much as possible 
with the knife, scissors and Volkmann's spoon, and 
swab the raw- surface with a solution of chloride of 
zinc, grs. xl— gi. A large circular wound will be left, 



106 DIGEST OF EXTERNAL THERAPEUTICS. 

which is painted with carbolic acid, alcohol, methyl 
violet, each part, water 10 parts, then dust with 
iodoform and pack with iodoform gauze. The in- 
cision should be made deep around the circumference, 
at least half an inch from the infected part. Haem- 
orrhage may be guarded against by pressure forceps 
in the hands of an assistant. After excision great 
care must be taken not to infect the wound. (T. 97). 

Crucial Incision with Carbolic Acid Injections: — 
When excision is impracticable multiple crucial inci- 
sions may be made across the surface of the carbun- 
cle ; then inject hypodermically carbolic acid 1—10. 
The injections should be made carefully, so as to 
diffuse the solution throughout the base of the in- 
fected part, and the puncture must be made deep, 
drawing the needle slowly while injecting a few 
drops. The incision must be carefully mopped out 
with the acid ; then compresses wet with a solution 
of bichloride, 1—1000 applied, and an ice bag over the 
dressing. The injections are to be repeated every six 
hours until the disease is under control. (A.) 

Crocker recommended Glycerine of Belladonna 
spread on lint, followed later by Ung. Resinse until 
suppuration occurred ; then the removal of the 
sloughs with the scissors when they are slow in sep- 
arating, or when septic absorption is threatened . The 
wound is dressed antiseptically. (Hd.) 

Iodine Liniment: — Painted freely on the part, fol- 
lowed by the application of a thick pad kept in place 
by an elastic bandage is recommended. When the 
carbuncle is situated on the limb it is claimed that 
relief is very marked, and that the patient can be 
permitted to go about. (T. 97.) 

Antiseptic Irrigating solutions (see also Abscess). 



CARIES AND NECROSIS OF BONE. 107 

Hydrarg. Bichlorid., 1-2000 or 1-3000. 

Potass. Permang., grs. x-gi. 

Hydrogen Peroxide. 

Dusting powders are indicated during the process 
of healing. Acetanilid, Airol, Dermatol, Iodoform, 
Pyoktanin Blue, 1-2 per cent., Resorcin, etc. 



CARIES AND NECROSIS OF BONE. 

Iodoform: — 1 part to 10 of glycerine was used by 
Billroth in tuberculous caries, viz : The abscess was 
first opened, the bone scraped, the cavity thoroughly 
cleansed and firmly rubbed with a pledget of iodoform 
gauze. The wound was then stitched up, leaving an 
opening in which the iodoform emulsion was poured. 
Recovery by first intention may be expected. Usually 
a second dressing will be required. (Sm.) 

Myrrh: — When the discharge is very offensive this 
will form a useful stimulating dressing. It may be 
combined with potassium chlorate in the proportion 
of 2 drachms of each to 4 ounces of distilled water. 
(Al.) 

Turpentine: — Diluted with olive or almond oil is of 
especial value in caries of the temporal bone. Appli- 
cations may be made every 3 or 4 days. (Al.) 

Potass. Permang.: — Grs. iii-x— ^i, applied with a 
brush or compress. (F.) 

Liqueur de Villate: 



Cupri Sulph., 




Zinci Sulph., 


aa grs. xv 


Liq. Plumbi Subacetat., 


3ss. 


Acid. Acetici Dihit., 


5iiiss. 



108 DIGEST OF EXTERNAL THERAPEUTICS. 

A small quantity is injected into the sinus. It is 
claimed that only the outer portion of the bone be- 
comes decalcified. 

Acidulated Pepsin:— An artificial digestive fluid 
has been employed for the removal of dead bone from 
suppurating tracts. It is employed as follows : An 
opening is made in the soft parts by the most direct 
route to the diseased bone, then, if possible, the sinuses 
are made to connect and are kept patulous by plugs 
of antiseptic gauze. A 3 per cent, solution of hydro- 
chloric acid is then injected. This may be done every 
two hours if the patient is confined to bed ; if not, 
once daily. After decalcification of the exposed bone 
flush the sinus with hydrogen peroxide or bichloride 
of mercury, 1-2000, and inject the following : 

Pepsin., 3 SS - 

Acid, Hydrochloric, » Mxvi. 

Aq. Destill., ^iv. 

Digestion of the bone and tissue detritus will take 
place in about 2 hours. The procedure may be re- 
peated in two days. (Al.) 

Lactic Acid: — The concentrated acid has been used 
on lint or absorbent cotton covered with an imper- 
meable tissue and bandaged incases of fungous caries. 
The healthy skin should be protected with adhesive 
plaster; after twelve hours remove the caustic, 
cleanse the part and apply moist dressings for twelve 
to twenty-four hours. The acid may be repeated as 
often as necessary. (F.) 

Nitric Acid: — As a caustic to hasten suppuration, 
especially when there is sloughing of the soft parts. 
(N.) 

Sulphuric Acid: — A swab on an aluminum appli- 
cator may be applied to the necrosed bone, especially 



CARIES OF TEETH. 109 

when exfoliation is slow. The effect is solvent and 
cauterant, and tends to the removal of diseased part. 

(F.) 

Hydrochloric Acid: — The dilute acid has been used 
as an injection in tuberculous caries. 

The pure acid has also been employed, a few drops 
being applied directly by means of a glass pipette to 
the diseased bone and allowed to remain on for one 
minute; afterwards irrigate with a saturated solu- 
tion of carbonate of soda and apply myrrh dress- 
ings. (F.) 

Operation: — When possible, is generally preferred to 
anv other method. 



CARIES OF TEETH. 

Gum Mastiche: — Often employed as a temporary 
filling, in solution with ether, 1-4 ; a small piece of 
cotton being saturated with the solution is pressed 
down into the cavity, which should be previously 
cleansed. (Al.) 

Myrrh: — Serviceable as a mouth wash, viz : 

Potass. Chlorat., 3 ii. 

Tr. Myrrh., gii. 

Aq. Destill., q. s. ad. ^vi. (Al.), 

H'ydronaphthol: — As a mouth wash and preventive 
of dental caries, viz : 

Hydronaphthol., grs. xvi. 

Alcohol., £i. 

Aq. Destill., ^i. 

A tablespoonful to half a pint of water. Use freely. 

It should be made in small quantities, since the 

preparation is unstable. (Al.) 



110 DIGEST OF EXTERNAL THERAPEUTICS. 

Creosote Collodion: — Recommended as an appli- 
cation to the cavities of carious teeth. (F.) 

Ethyl Chloride: — This agent may be used as a den- 
tal anaesthetic, viz : First, thoroughly dry the gum 
and cover it with vaseline, and protect the neighbor- 
ing parts with wool. The patient should be in- 
structed to breathe through the nose. The chloride 
may be applied to both sides of the tooth, freezing 
the parts. In extraction it is not necessary to spray 
on both sides of the tooth, the jet may be thrown 
near the entrance of the dental nerve in front of the 
ear for the upper ; and behind the ramus of the in- 
ferior maxilla for the lower jaw. Anaesthesia of the 
whole jaw, it is claimed, will follow, and a tooth may 
be extracted without pain. During the thawing, care 
must be observed in the use of hot water, if used too 
hot or too soon sloughing will follow. (F.) 



CELLULITIS. 

(See Phlegmonous Erysipelas.) 

CERUMEN.— INSPISSATED AND IM- 
PACTED. 

Vaseline, Olive Oil, or Glycerine: — The latter the 
most effective warmed and dropped into the ear and 
retained by pledgets of cotton, are useful for soften- 
ing the wax before syringing. The oil and glycerine 
should be allowed to remain twenty-four hours. 
(Bp.j 



CHANCRE — HARD. Ill 

Sodium Bicarbonate: — Grs. iv— ^i, with warm water 
or glycerine ; fill the ear several times a day with the 
solution ; allow it to remain for about fifteen minutes, 
the mass will then break up and can be easily re- 
moved by injection. The auditory canal should af- 
terwards be dried, anointed with vaseline, and pro- 
tected with cotton. (Bp.) 

Papain: — Grs. xx-gi. Liquor Potassse: — 10 per cent, 
solution. Hydrogen Peroxide: — Full strength, are 
also useful for the removal of inspissated cerumen. 
(Al.) 



CHAFING. 

(See Erythema Intertrigo). 

CHANCRE HARD. 

Strict Cleanliness is of great importance. The part 
should be bathed frequently in tepid water or some 
antiseptic lotion. Usually simple dressings in the 
form of dusting powder are effective in healing the 
local sore. Iodoform formerly headed the list, but 
some of the odorless dusting powders may be substi- 
tuted, such as Aristol, Europhen or Bismuth Subni- 
trate. Sometimes a simple piece of lint laid on the 
erosion will be all that is necessary. (CI.) 

Calomel: — Used as a dry dressing with equal parts 
of zinc oxide. (B. H.) 

Hydrogen Peroxide: — Wash the part three times a 
day in the pure peroxide and apply lint soaked in the 
same. (R.) 

Lotio Nigra and Lotio Flava: — Old but none the 



112 DIGEST OF EXTERNAL THERAPEUTICS. 

less effective remedies, especially for indolent sores. 
(N.) 

Ung. Hydrarg: — If there is much induration the 
officinal ointment may be used, protecting the sur- 
rounding part by proper dressings. Or if this is too 
irritating the following : 

Hydrarg. Praecipit. Alb., grs. xl. 

Adipis Benzoat., %i. 

Or, 

Ung. Hydrarg., 

Zinc. Oxidi, 

Amyli, aa ^ii. 

Adipis Benzoat., ^i. (B. H.) 

The weight of evidence is strongly against the 
utility of excision and cauterization, as well as the 
effectiveness of antiseptic lotions and local applica- 
tions of mercury as preventives or abortives of con- 
stitutional symptoms. (CI.) 

If the chancre does not heal but presents an exten- 
sive ulcerating surface, or appears to be of the mixed 
variety, the same treatment as for chancroid will be 
indicated. 



CHANCROID. 

It has long been the custom with many surgeons to 
cauterize all chancroids ; but modern antisepsis has 
modified this routine treatment. In a large majority 
of cases daily irrigation with a solution of Corrosive 
Sublimate, 1-500 or 1-1000, followed by the free ap- 
plication of Iodoform, or an ointment of the same, in 
the strength of 90 grs. to vaseline 1 oz., will be fol- 



CHANCROID. 113 

lowed by cicatrization. If this fails, pledgets of lint 
soaked in a Boric Acid solution or in Peroxide of Hy- 
drogen kept continuously applied will often result in 
a cure. Should, however, these measures in turn 
prove unsuccessful and the sore deepen and extend, it 
should be cauterized. (A.) 

Cauterization : — This is recommended by not a few 
authorities as the first remedial measure ; but others 
limit its application to those cases in which antisep- 
tic treatment has failed and to the severer forms of 
the lesion. Before application the sore should first be 
cleansed and dried. 

The contra-indications for the uses of cauterizing 
agents are when the surface involved is large and 
there is evidence of healthy reaction about to take 
place; when there is much inflammation; and when 
the sore is situated at the meatus urinarius. The 
objections to their use are the pain and inflamma- 
tory action which follows, the possible production of 
phimosis and the subsequent effusion of lymph, 
which is apt to cause indurations closely resembling 
hard chancre, and thus obscure diagnosis. (A.) 

Nitric Acid: — The most frequently used cauterant, 
should be applied as follows : The chancroid is dried 
with absorbent cotton ; then cleansed with hydrogen 
peroxide and again dried. The parts are now so held 
as to give them as much as possible a cup-like depres- 
sion looking upward. This is filled with one drop or 
more of the acid by means of a glass rod ; in a few 
minutes the part will turn white. The acid should 
be allowed to overlap the original margin of the 
sore. The superabundant acid must now be removed 
with cotton and a drop of carbolic acid applied to 
relieve the pain ; the ulcer is now dressed with a dust- 
ing powder. (CI.) 
9 



114 DIGEST OF EXTERNAL THERAPEUTICS. 

Sulphuric Acid: — This is hardly to be preferred to 
nitric acid, as it penetrates more deeply and is not 
easily controlled. Combined with charcoal (Ricord's 
Paste) , with asbestos (Michel's Paste) , or with saffron 
(Velpau's Paste) it is more manageable. (F.) It 
should be pressed down well into the irregularities of 
the surface, where it remains a black crust ; after a 
few days this will come away and leave a healthy 
surface. (CI.) 

Acid Nitrate of Mercury: — One of the best caus- 
tics; apply with a glass rod. (B.) 

Actual Cautery: — This agent acts well when the 
lesions are small and few in number. It should burn 
deeply so that the surface of the sores are well 
charred. Apply cold water dressings until the eschar 
comes off. (CI.) 

Radiant Heat: — The therm o-cautery is brought 
close to the sore, but not in actual contact, and held 
there for a few seconds. This dries up the ulcer, upon 
the edges of which sanguinolent striae appear. Too 
long application should be avoided lest blisters form. 
A single application will transfer the lesion into a 
simple ulcer, which will heal rapidly under antiseptic 
powders ; more so than when the actual cautery is 
used. (D. H.) 

General indications for dressings may be summar- 
ized as follows : For acute inflamed and painful 
sores, sedative lotions, such as lead water, lead and 
opium wash, sulphate of zinc and opium ; for indo- 
lent pale ulcerations, stimulating applications, such 
as strong zinc solutions, nitrate of silver, etc. (A.) 

All dressings should be removed with great care; if 
adherent, they should be softened in order to avoid 
tearing the sore, thus favoring re-inoculation. 



CHANCROID. 115 

Moist Dressings : 

Hydrogen Peroxide, 

Mercuric Bichloride, 1-3000 or 4000, 

Carbolic Acid, 1-60. 

The sore should be sprayed .with the selected solu- 
tion and a pledget of lint soaked in the same kept ap- 
plied and changed three times a day. (CI.) 

Dry Dressings : — These are indicated at any and all 
times. 

Iodoform : — Stands first. Holmes said that the 
treatment of chancroid is now reduced to a simple 
matter in the majority of cases. There are few which 
will not yield to the application of iodoform. (HI.) 

Europhen, Di-iodoform, Acetanilid, Aristol, Trau- 
matol, etc.: — The last has been used with great suc- 
cess as a substitute for iodoform ; it has the advan- 
tage of being non-poisonous and non -irritating. (F.) 

Calomel : — Useful to complete the healing process. 
(Cl.) 

Guaicol: — Gently applied at first in order to anaes- 
thetize, then mopped on freely, for its caustic effect, is 
reported to have brought about a speedy cure in all 
but one of thirty cases. (J. de P.) 

Bromine: — 10 minims to 1 ounce of olive oil forms 
a sedative dressing. (Sm.) Cocaine: — 4 per cent, or 
stronger solutions to render cauterization pain- 
less. (Al.) Pyrogallic Acid:— As a powder, 25 per 
cent, with starch or a 5 per cent, paste acts well. It 
does not attack healthy skin. Apply night and 
morning and cover with gutta percha. It should be 
continued until granulations appear, after which 
oxide of zinc or calomel should be dusted on. (Cl.) 

Alumnol: — 10 per cent, dusting powders are useful. 

(F.) 



116 DIGEST OF EXTERNAL THERAPEUTICS. 

Pixol: — 10—13 per cent, solutions painted on the 
sore will promote healing. (F.) 

Iodoform and Glycerine: — May be preferred to 
iodoform alone as an application to crevices. (D. H.) 

Hot Water: — When there is extensive inflammation, 
immersion of the part in a cup of hot water three or 
four times a day or a prolonged sitz bath are very 
beneficial. (D. H.) 

Charcoal Poultice and Potassium Permanganate 
in weak solutions are indicated when the sore is 
gangrenous. (CI.) 

Ointments hold a secondar}^ position and are con- 
demned by some observers. They may, however, 
have been preferable in some cases. The following 
are recommended : 



Hydrarg. Chlorid. 


Mitis, 


grs. x. 


Naphthalini, 




3i- 


Ung. Camphorae, 




3vii. 


Pyoktanin. (Blue), 


\ 




Potass. Bicarb., 




aa grs. xv 


Aq. Destill., 




§iii. 


Alcohol., 




3v. 


Reduce by heat to 3 iii and add 




Pyoktanin. (Blue), 






Sod. Biborat., 




aa grs. xv. 


Aq. Destill., 




3 iii. 


Resorcini, 




3i-ii. 


Vaselini, 




ifi- 



(Sm.) 

Subpreputial Chancroids : — Inject warm salt water 
every two or three hours, following with a solution 
of Potass. Permang. grs. i— x— ^i, or Nitrate of 
Silver grs. x-xv— gi, or a mixture of Balsam of Peru 
and Iodoform. An offensive odor from the discharge 
indicates a tendency to gangrene. In this case the 
prepuce should be slit up, the glans penis exposed, 



CHAPS AND FISSURES OF THE HANDS AND LIPS. 117 

and the appropriate treatment applied. When the 
fraenum has been destroyed it should be ligated or 
cauterized. (CI.) 

PHAGEDENIC CHANCROID. (See also Phage- 
dena.) 

Rest in bed with antiseptic dressings, notably 
Iodoform (Ga.) The Acid Cauterants as mentioned 
are generally indicated. Curettage in recommended 
by Carleton before the application of nitric acid. 
Potassium Permanganate:— Grs. xl-lx-gi for applica- 
tion to the sore ; then dress with lint saturated in a 
solution grs. i— ii— ^i. (D. H.) Menthol-Phenol: — 3 
per cent, in hot water for bathing the part frequently. 
(F.). Carbolic Acid: — A few drops of the pure acid 
applied daily. Pyrogallic Acid and Sulphuric Acid 
paste as mentioned. Bromine: — Solution of 1—500 
for continuous application. (CI.) Hot Water: — 
Immersion of the part in hot water, as recommended 
for inflammation, is also beneficial in this form. (Ga.) 

Actual Cautery:— If milder measures fail, apply the 
Paquelin or galvano-cautery ; the latter is decidedly 
preferable as it is more easily controlled. Cases 
which have resisted all other measures may be ar- 
rested by this agent. 

Boric Acid: — Saturated solutions are serviceable 
dressings after cauterization. (CI.) 



CHAPS AND FISSURES OF THE 
HANDS AND LIPS. 

Bismuth Subnitrate, as a powder, Rose Water 
Ointment, Cold Cream, Glycerine with Egg Yolk or 
with equal parts of Bay Rum, or with equal parts of 



118 DIGEST OF EXTERNAL THERAPEUTICS. 

Benzoin, Glycerole of Starch, Lanolin, Mutton Suet, 
Nitrate of Lead grs. x— §i (the last as a secret remedy 
is much employed in Europe), all useful for the hands 
or lips. 
The following are of service 

Camphor. , 7, ss. 

Acid. Carbolici, M iv. 

01. Neroli, Miii. 
Sevi, ^ii. 

Soften a small bit and apply. 

Hydrarg. Oxid. Rub., ^iii. 

Cerat. Benzoin., Ji. (Sm.) 

For fissured lips and cracks at mouth corners, the 
fissure should be filled and distended with the oint- 
ment repeatedly. A cicatricial tissue will be pro- 
duced which will prevent subsequent Assuring. 

Gutta percha in solution, or Collodion: — As protec- 
tees. 

The following are for chapped hands. 

Menthol, grs. x. 

Olive Oil, 

Salol, aa Mxx. 

Lanolin, 3 iss. 

Apply twice daily. 

Lanolin, ^iii- 

Glycerine, ^iv. 

Boric Acid, 3 iss. 

Salol, gi. 

Menthol, grs. xv. 

Oil of Citronella, M iii. (T. 98.) 

Emol Keleet: — Said to be the best preparation 
for deeply fissured skin. 

Emol. Keleet., 3ii. 

Zinc. Oxid., <?*• 

Glycefini Plumb. Subacetat., q. s. 

Lanolini, E ss - 

Vaselini, t ?ss. (T. 98.) 



CHILBLAIN. 119 

Use sufficient glycerine of acetate of lead to form the powder 
into a paste, then add the lanolin and vaseline. 

It should be applied at night and the hand covered with lint. 

Cerates of Hydrastis, Calendula, Graphites, Borax: 
(Bt.) Court Plaster will often speedily heal fissures 
on the hands in some persons. 



CHILBLAIN. 

General indications in the chronic form when the skin 
is unbroken call for stimulating and astringent ap- 
plications ; in especially chronic cases Galvanism is 
effective. When ulcers form they must be treated on 
general principles. (A.) 

The following applied by painting on the affected 
part are recommended when the skin is unbroken : 
Tr. Tamus Communis and Tr. Benzoin. Great 
claims are made for both these remedies. Oil of Caju- 
put, Tr. Capsicum, diluted, or Oil of Black Pepper 
and Tr. Cantharidis, equal parts, Collodion and 
Glycerine, equal parts, Tr. Iodine, Tr. Aconite to 
allay the burning and tingling. (Al., Rd., Kp., Bt.) 

Turpentine. — In combination as follows : 

Venice Turpentine , 3 vi . 

Collodion, 3 ii 

Castor Oil, 3m. (HI.) 

When there is great tenderness of the surface ; or 

Oil of Turpentine, 3 ss. 

Naphthol, grs. xv. 

Lanolim, 5ss. (Sh.) 

Tr. Rhus Tox., sss-gi., Tr. Calendula, or Tr. 
Hamamelis, 1 part of either to 4 of water. (Rd.) 



120 DIGEST OF EXTERNAL THERAPEUTICS. 

Wet Compresses covered with oiled silk will afford 
marked relief. Fomentations of Flaxseed Meal or 
Marsh Mallow are also useful for relieving pains. (Bt.) 

Ichthyol: — This is an effective remedy, and is used 
with equal parts of Resorcin and Tannin in 150 
parts of water ; the mixture must be well shaken be- 
fore applying. The affected parts should be painted 
at night. After the first application it forms a 
glazed surface. Under its influence the skin shrivels 
and the cedema as well as the chilblains disappear. 
(T. 97.). ' 

Carbolic Acid: — Used in various ways with good 
results ; a 5 per cent, solution ; or the following oint- 
ments : 

Acid. Carbolici, grs. xvss. 

Ung. Plumbi, 

Lanolini, aa 3 v. 
Ol. Amygdalae, ^iiss. 

Ol. Lavandulae, gtts. xx. (Al.) 

This makes a soft ointment. 

or, 

Acid. Carbolici, ^i. 

Tr. Iodi, 3ii. 

Acid. Tannici, gii. 

Cerat. Simp., ^iv. (B.) 

Acid. Carbolici, grs. iii. 

Lanolini, ^ss. 

Pulv. Camphor., ^ss. (Sh.) 

Plumbi Acetat., viz.: 

Plumbi Subacetat., 9iiss. 

Cerae flav., ^iss. 

01. Rapi, |i 

Ovi Vitelli, No. 1. 

Liq. Plumbi Subacetat., 

Creosoti, aa gtts. x. 

Ext. Opii, grs. iss. 

Adipis, gi. (Al.) 



CHLOASMA. 121 

Aconite and Chloroform Liniment is one of the 
best applications; Sulphurous Acid, 31—51, with a 
little glycerine, acts quickly (Bt.); Wardrop's Lini- 
ment, 2 parts of tr. camphor with 6 parts of soap 
liniment; Mustard Foot Bath for the itching. (HI.) 

Decoction of Walnut Leaves is useful for bathing 
the parts, which should be then dried and rubbed 
with Spts. Camphor; after this dust on Salicylate of 
Bismuth, 10 per cent, in powdered starch. (Sj.) 

Resorcin: — Sometimes is very effective, it may be 
used as follows: 

Resorcin, 1 part. 

Ichthyol, 1 part. 

Tannic Acid, 1 part. 

Water, 5 parts. 

The mixture must be shaken and painted on at 
night. It is not to be applied in irritable chilblain. It 
dries the skin and is sometimes badly borne. (T. 97.) 
The following ointments are of service : 
Ung. Balsam Peru, Ung. Zinc. Oxid., Ung. Iodi. 
When ulceration appears the f ollowing : 

Balsam. Peru , £i. 

Ung. Hydrarg. Nit., 3 ii. 

Zinc. Carb., ^i. 

Ung. Aq. Rosae, ^i. 



Ung. Plumbi Subacetat., 


gss. 


Kxt. Arnicse, 


3 SS - 


Ext. Cocas Erythrox., 


3ss. 


Ol. Anthemidis, 


gtts. V 


Ung. Aq. Rosae, 


^ss. 



(Sh.) 



CHLOASMA. 

In selecting local applications great care should be 
exercised to avoid the use of agents which may cause 



122 DIGEST OF EXTERNAL THERAPEUTICS. 

discoloration of the skin, such as mineral acids, mus- 
tards or croton oil. (Sh.) 

Hydrarg. Bichlorid.:— This remedy is much used; 
the following are some of its methods of application: 

Hydrarg. Bichlorid., grs. iii. 

Aq. Destill., %i. (Pf.) 

Hydrarg. Bichlorid., grs. ii. 

Emulsion. Amygdal., £i. 

Apply night and morning. (Kp.) 

Hebra's method consists of applying a solution of 
the bichloride, grs. v-^i, by means of a compress, for 
five hours. A blister will result which should be 
punctured and powdered with starch. The new ep- 
idermis wall be lighter but it will not remain so. (Sh.) 

Bulkley recommends the following : 

Hydrarg. Bichlorid., grs. vi. 

Acid. Acetici diluti, 3 ii. 

Boracis, 9ii. 

Aq. Rosae, ad. ^iv. 

To be applied night and morning, at first gently 
brushed over the affected part, then afterwards rubbed 
on. If the skin becomes too scaly, suspend the appli- 
cation for a day or tw^o and apply vaseline. 

The following is also recommended : 

Hydrarg. Bichlorid., grs. vss. 

Zinc. Sulphatis, 

Plumbi Subacetatis, aa 3 ss. 

Aquae, ,^iv. (Vn.) 

Unna first washes the part with Spirits of Wine 
then applies a Mercurial Plaster made from the 
White Precipitate ; this is allowed to remain on 
over night and the following used : 

Bismuth. Subnit., ^iss. 

Kaolini, ^iss. 

Vaseline, 3 vi- £ iss. (Sh. ) 



CHOLERA ASIATICA. 123 

Copper Oleate : — In oleo-palmetic acid, sufficient to 
make a soft ointment, is recommended by Kippax. 

Ung. Hydrarg. Oleate, Ung. Hydrarg. Nitrate, pure 
or diluted; Tr. Iodine, Veratria, grs. x-xxx-^j ; 
Potash Soap, applied continuously for four hours or 
the entire day. (Sh..) Tr. Benzoin, equal parts 
with alcohol, applied daily until desquamation oc- 
curs. (Pf.) 

See also Lentigo. 



CHOLERA ASIATICA. 

Method of Cantani: — This is indicated in the stage 
of serous diarrhoea and in the algid state. (An.) It 
consists essentially in supplying to the system the 
water of which it has been deprived ; this may be ac- 
complished by intestinal injections of water, viz: En- 
teroclysis and hypodermatic injection, hypodermo- 
clysis. (Gn.) 

Enteroclysis: — Indicated in the premonitory diar- 
rhoea. It may be administered by a long rectal tube. 
To secure retention it must be given slowly ; if ex- 
pelled it will serve the purpose of irrigation, but 
should be persisted in. The injection should consist 
of an infusion of chamomile containing 5—25 
grams of tannic acid, and 20—30 drops of lauda- 
num, and 20—50 grams of gum arabic. The tem- 
perature of the fluid should be 100°-104°. The 
dose for an adult is from 1-2 quarts. The injec- 
tions should be repeated four times a day, and in 
grave cases after each movement. (Gn.) 

The formula of Cantani is elsewhere given with 
water as a base instead of infusion of chamomile and 
wine of opium instead of laudanum. (Sm.) 



124 DIGEST OF EXTERNAL THERAPEUTICS. 

Hypodermoclysis: — In the later or algid stage, hy- 
podermatic injections of artificial serum are indicated. 
This is accomplished with a fountain syringe to 
which a perforated needle is attached. Strict anti- 
sepsis should be observed in all details. The artificial 
serum consists of the following : 

Sodium Chloride, 4 grains ( %i). 

Sodium Carbonate, 3 grams (grs. xlv). 

Sterilized Water, 1 litre ( 1 qt. ) 

This amount is to be inserted at one time and re- 
peated subsequently as required. The temperature 
of the fluid should be 100°— 104° or higher if it can be 
tolerated. (Gn.) 

The points of injection are usually the buttock, 
flank, thighs or below the pectoral muscles. 

Intravenous Injections of Saline or Milk: — These 
are indicated in the algid stage, but hypodermoclysis 
is to be preferred. (Gn.) A formula for the fluid is 
as follows : 

Sodium Sulphate, ^iiss. 

Sodium Chloride, £i. 

Distilled Water, Oii. 
Inject six ounces slowly. (T-98.) 

Mustard Sinapisms: — Large size plasters to the 
epigastrium and abdomen for the relief of vomiting 
and pain. (Gn.) 

After vomiting, the patient's mouth should be rinsed 
with a solution of Hydronaphthol, 1—5000, taking 
care that none is swallowed, and after each move- 
ment the buttocks, thighs and anus should be washed 
with soap and water. All vomited matter and dis- 
charges from the bowels should be gathered in a so- 
lution of carbolic acid 1—20, or chlorinated lime 1—10, 



CHOLERA INFANTUM. 125 

some of which should be in the vessel when used. 
The water thus collected should be mixed -with more 
of the disinfectant, stirred and allowed to stand 
twenty minutes before throwing into the closet. (Ty.) 

Heat: — Hot water bags and bottles, flannels wrung 
out in hot water applied to the abdomen and fre- 
quently changed are used for the relief of pain. (Gn.) 

Stimulation of the Surface by friction, kneading 
and rubbing with mustard water to relieve cramps 
and to stimulate the circulation should be employed. 
(Gn.) 

Methylene Violet: — 15—45 minims of a 1 per cent, 
solution subcutaneously every 3-4 hours. (Sj.) 

Chloral Hydrate and Morphine: — The following to 
be given subcutaneously in doses of 15—30 minims is 
highly recommended for the collapse : 

Chloral Hydrate, ^ iii. 

Morphia Sulphate, gr. iv. 

Cherry Laurel Water, ^ i. 

The injection will cause burning and irritation, but 
suppuration has not f ollowed according to Bartho- 
low. 

Nitro-Glycerine, Atropine and Ether hypodermic- 
ally for stimulating the heart. (Bt.) 

In severe cases all medicines may be administered 
hypodermically for speedy action. (Bt.) 



CHOLERA INFANTUM. 

Washing Out the Stomach and Irrigation of the 
Colon: — These are very important measures for the 
removal of the poison, which is one of the first indi- 
cations of treatment. The irrigation of the intestines 



126 DIGEST OF EXTERNAL THERAPEUTICS. 

should be thorough, using sterilized water, with or 
without Castile soap. The water may be tepid, or 
cold if the temperature is high, and the irrigation 
continued until it comes out clear. This procedure 
should be repeated on the return of the vomiting and 
purging. A flexible rubber catheter introduced six or 
eight inches may be used for the bowel. Objections 
to these methods on account of their supposed sever- 
ity are mostly imaginary. (Gn.) 

Opium: — Must be used with extreme caution in 
young children, who are very susceptible to its influ- 
ence. It is valuable when there is much pain and irri- 
tability, and may be administered by enema, 2—5 
drops in starch to an infant six to twelve months 
old. The effect must be carefully watched. The dose 
may be repeated in from six to twelve hours if neces- 
sary. (A. W.) 

Morphine and Atropine: — These drugs must also 
be administered with great care to young children. 
Holt gives T ^o gr. of morphia with -g-J-g- gr. of atropia 
for the first dose to an infant of one year. When stu- 
por or collapse seems imminent, they are especially 
contra-indicated. (An.) The symptoms are the same 
as those calling for opium. These remedies are not 
often required, as others administered internally ren- 
der their use infrequent ; they are nevertheless at 
times invaluable. 

Saline Injection: — As it is impossible to supply 
water to the exhausted tissues by the mouth or rec- 
tum, injection into the cellular tissues of the thighs 
and buttocks of a solution of 4 grains of common salt 
to a pint of sterilized water may be practiced with 
good effect. One pint, and often larger quantities, 
may be thus administered in twenty -four hours with 
advantage. (An.) 



CHORDEE. 127 

Salicylie Acid: — 5 grs. in starch by injection has 
done good service. (Bt.) Hot Mustard Baths: — In 
bad cases for the relief of intestinal congestion and 
cutaneous circulation. (F.) Brandy Compresses: — 
Cloths soaked in brandy laid over the abdomen and 
covered with oiled silk. (Bt.) Ice Bag: — May be ap- 
plied to the spine for the relief of cramps of the leg 
(Gn.) and to the head to control temperature. (An. ) 

Cool Sponging: — With gentle friction may be used 
frequently if there is much fever. (Gn., A. W.) 

Keep the abdomen and extremities covered with 
flannel and the child out in the open air as much as 
possible. A cool place should be selected if practica- 
ble, but care should be observed not to chill. 



CHORDEE. 

The application of Cold in some form, such as ice 
cold metal or immersing the penis in cold water or a 
cold sitz bath is usually effective. 

Gallobromal: — Urethral injections of 1—2 per cent, 
solutions. (F.) 

Hop Poultice: — Applied to the penis during gonor- 
rhoea will assist in preventing. 

Morphia: — Subcutaneously in doses of i gr. before 
retiring. 

Suppositories containing Belladonna or Opium are 
effective, but, as a rule, cause constipation; if necess- 
ary, the following is suggested: 

Opium, i grain. 

Powd. Camphor, 3 grains. 

Oil of Theobroma, q. s. (A. ) 

Leeches: — In obstinate cases these will prove valu- 
able; eight to ten ounces of blood may be abstracted. 



128 DIGEST OF EXTERNAL THERAPEUTICS. 

For the following two or three days the patient 
should occupy a strictly recumbent posture. (A.) 



CHOREA. 

Hydrotherapy: — The wet pack is advised as effect- 
ive : — A sheet is dipped in water at 50°— 54°, then 
lightly wrung out, spread on a mattress covered with 
oiled cloth, then closely wrapped around the patient 
who is rubbed from head to foot and placed between 
woolen blankets and returned to bed. (Sj.) The spinal 
douche is also emplo\ r ed, the temperature varying, ac- 
cording to the severity of the case, from lukewarm in 
the beginning to colder, lowering the temperature 
clay by day as the patient improves. (T. 96.) 

Electricity: — Central galvanization and general 
faradization act favorably. The galvanic current is 
preferable for vigorous children, the faradic for the 
anaemic and weak. (Sj.) Static electricity often 
gives brilliant results ; some cases may be treated by 
the constant current and the static in combination. 
(Bw.) 

Systematic Muscular Exercise: — Has been success- 
ful in cases of long standing. (T. 98.) 

Rest: — Put the patient in bed and keep him there 
according to the severity of the case, three weeks 
being usually necessary. The rest should be complete 
both mentally and physically. (Sj.) 

CICATRICES. 

Massage and Electricity: — Galvanism, electro-mas- 
sage (faradism) and electrolysis are all employed, 



CICATRICES. 129 

the latter especially, for the removal of hardened and 
hypertrophied new formations, and for atrophic cic- 
atrices when not very numerous. (F.) 

The following applied to granulating surfaces will 
prevent, it is claimed, scars appearing unsightly 

Sod. Biborat., ^iss. 

Sod. Salicylate, grs. xii. 

Glycerini, giii. 

Aqua Rosae, ^vi. 
Apply frequently. 

Or, 

Ferri Chloridi, 31. 

Collodii, gii. 

Apply daily. (Bt.) 

Thiosinamine: — Cicatricial contractures have been 
greatly benefited by hypodermic injections of this 
drug in alcoholic solution, 15 percent., or in solution 
with equal parts of glycerine and water; the latter is 
not as painful as in alcohol and is just as active. Ec- 
tropion from lupus, talipinus equinus, etc., have been 
much benefited by its use. The dose is %-% gr. 
twice daily at the beginning, and gradually increased, 
rarely exceeding 1*4 grs. Hebra seldom gave as much 
as 3 grains, beginning with the smallest dose, though 
other observers cited by him gave as much as 4 grains, 
commencing with the smallest dose. Hebra suspended 
treatment for ten days every six weeks to two 
months. (F.) 

Excision: — When the neighboring parts and the 
surrounding tissues admit, plastic surgery should be 
considered. 



10 



130 DIGEST OF EXTERNAL THERAPEUTICS. 



COLD— EFFECTS OF. 

FROST BITE: 

Gradual Application of Warmth: — While there is 
some difference of opinion as to whether warmth 
should be gradually or suddenly applied, most ob- 
servers favor a gradual transition from cold to heat, 
which may be employed in the following manner : 
Rub the part with snow or immerse it in ice water, 
the patient during the procedure being kept in a cool 
room, avoid even the warmth of the bed, which has 
been known to set up inflammation with a tendency 
to run on to gangrene. As soon as the bodily tem- 
perature and that of the part involved has become 
about normal, stimulating friction should be applied, 
such as Soap Liniment, Alcohol diluted with water 
or Spts. Camphor. (A.) 

Immediate Application of Warmth: — The immer- 
sion of the affected part in a hot bath at once is ad- 
vocated by Shoemaker. 

This is contrary to general usage. 

The following are recommended for application 
after reaction has set in, the parts should afterwards 
be well enveloped in cotton : 

Tr. Benzoin Comp: — Alone or in combination with 
Chloroform, 3 parts tol painted on, acts well. (Sh.) 

Nitrate of Silver: — Grs. v— ^i, applied with a brush. 

(W. C.) 

Cocaine Hydrochlorate: — 1—10 per cent, in Pepper- 
mint Water, useful for allaying irritation and itch- 
ing. (Sh.) 

Aluminum Acetico Tartaricum: — A 50 per cent, so- 
lution is astringent, antiseptic and non-toxic. (Sn.) 



COLD— EFFECTS OF. 131 

Alcohol: — In the following formula may be applied 
with old linen : 

Alcohol, § ii. 

Cocaine Hydrochlorat. , grs. v. 

Boric Acid, 3 i. ( F. ) 

Ung. Acid. Carbolici. — Grs.xx—^i, useful for painful 
ulcerations of the fingers and toes. It relieves pain 
promptly and promotes resolution. (Al.) 

Thiol: — In the form of a powder, viz : 

Thioli Siccse, ^i. 

Zinc. Oxidi, 3 ii. 

Talci, gii. 

Or in an ointment, 

Thioli, 

Vaselini, aa £i. 

Lanolini, ^i. (Al.) 

Acetanilid: — When the parts are raw and exposed, 
an ointment may be ordered. (Sj.) 

Phulluah: — This drug is largely used as a liniment 
among the Hill tribes of India ; it is a stimulant, 
emollient, anodyne and antiseptic. (F.) 

Ichthyol: — Has been found effective; may be used 
with lanolin in the proportion of 2 drachms to 6 02. 
(W. C.) (See also Chilblains.) 

General Depression From Cold. 

Treatment must be regulated by the degree of de- 
pression. While a fair pulse and consciousness re- 
main, warmth should be applied very cautiously and 
gradually. But if there be apparent death from cold, 
and the patient's limbs are rigid, he should be covered 
with snow to the depth of several inches, his mouth 
and nostrils only being left free. The melted snow 



132 DIGEST OF EXTERNAL THERAPEUTICS. 

should be replaced by fresh. If no snow be available, 
an iced salt bath for a few minutes may bring reac- 
tion. Where the limbs are less rigid, the clothing 
should be removed and the whole surface of the body 
briskly rubbed with snow or iced water until the 
pallor of the skin yields to redness. The rubbing 
should then be continued with dry flannels, and pres- 
ently the patient may be wrapped in a dry blanket 
and placed in a cool bed in a cool room. Injections 
of tepid camphorated water will promote revival, 
and, as soon as the patient can swallow, camphor 
should be administered. Ultimately warmth may be 
very gradually applied. In cases of suspended breath- 
ing, artificial respiration should be resorted to. (Rd., 
A.) 

COLIC. 

Heat: — This agent in some of the following forms 
is generally effective : hot water bags or bottles, hot 
plates, hot fomentations, mustard poultices, etc. 

Enema: — A copious injection of warm water will 
often relieve intestinal colic. (Rd.) 

Turpentine Stupes: — Have been used with good 
effect. (F.) Hot Baths: — These are especially ser- 
viceable in renal and hepatic colic. Morphia:— Sub- 
cutaneous injections are usually necessary in renal 
and hepatic forms. Chloroform: — Inferior to mor- 
phia but superior to baths or opium. (R.) 

COLLAPSE. 

Heat: — In the form of hot water bags and bottles 
should always be applied to extremities and sides. 
Strychnia Sulphate or Nitrate, ^"ro g r -> Whiskey 



COLLAPSE. 133 

or Brandy may be injected hypodermically, the lat- 
ter every 10 minutes in half drachm doses until reac- 
tion. (A.) 

Digitalis: — 15 minims every 15 minutes hypodermi- 
cally. Atropine t ±q gr. may be given with the first 
dose of Digitalis. (A.) 

Aqua Ammoniae: — 10—60 drops diluted with from 
1—8 drachms of sterilized water, injected into a vein, 
is of great benefit. (F.) 

Turpentine Enema: — Half an ounce rubbed up with 
raw egg in the form of an emulsion is a powerful 
stimulant. (A.) 

Camphorated Oil: — 1 part of camphor to 9 parts of 
aseptic sweet oil in doses of 15 minims, hypodermi- 
cally, is a prompt and powerful stimulant in cases of 
sudden prostration. (F.) 

The following line of treatment is for collapse after 
a prolonged operation, extensive loss of blood, and 
shock following severe injuries : Place the patient in 
such a position that the head will be lower than the 
body, apply around him hot water bottles and bags, 
and rub actively ; hypodermics of Ether or Caffeine. 
Brandy will be found beneficial ; likewise Champagne 
and by the rectum. For the purpose of stimulating 
the heart a momentary whiff of Nitrite of Amyl, and 
for stimulating the respiration, slap the face with a 
wet towel, also use Laborde's rhythmatic tractions 
of the tongue, inhalations of Oxygen and Silvester's 
method of Artificial Respiration. (T.-97.) 

Normal Saline Solution by transfusion will be 
found of the greatest service when haemorrhage is 
the cause. (T. 97.) 

Beef Extract in large doses by enema with hot wa- 
ter acts rapidly. (P.) 



134 DIGEST OF EXTERNAL THERAPEUTICS. 



COMA. 

Oxygen Inhalations: — Indicated when narcotic poi- 
soning is the cause, if persistently employed, life may 
be saved. Cold Douche: — For stupor of drunkenness 
and also for narcotic coma, should be kept up for 
some time if pulse and breathing continue good or 
become no worse. (Rd.) 

Blisters and Sinapisms: — Applied in quick success- 
ion ta the chest, abdomen, thighs and calves, are 
valuable in critical condition near the end of an 
acute illness, " only such cases to be selected as are to 
be tided over a dangerous point." (F.) Blisters to 
back of the neck. (Bt.) 

The following methods of treatment are applicable 
to coma due to affections of the brain and meninges 
(T. 97.): 

1. Place the patient in a well aired room. 

2. Massage entire body with alcohol and water. 

3. Apply sinapisms to the legs. 

4. Apply 4 leeches to the mastoid process or bleed 
from the arm. 

5. Give an enema of the following : 

Sodii Sulphat., ^i. 

Sennas Fol., ^ss. 

Aquae, Ad. ^viii. 
Et. Infusion. 

6. Practice rhythmical tractions of the tongue by 
the method of Laborde. 

7. If deglutition is too difficult to take food, give 
this enema : 

Yolk of ten eggs, 

Peptone, Dry, ^ss. 

Milk, ^viii. 



COMA. 135 

Chapman's Method of Ice to the Spine: — This may 
be employed effectively in apoplectic coma ; for the 
technique and indications see the subject under the 
head of Paralysis. 

For coma of infectious toxic origin give subcutane- 
ously every hour an injection alternately of Ether or 
Caffein : 

(i) Caffein., grs. xlv. 

Sod. Benzoat, ^i. 

Aq. Bullient., ^iii. 
Dose, mx. 

(2) Every four hours a tablespoonful by the 
mouth of the following : * 

Ammon. Acetat., §i. 

Tr. Moschi, grs. xv. 

Ess. Menth., M. iv. 

Tr. Jalap., ^iss. 

Tr. Gentian, q. s. Ad. ^iv. 

(3) Copious injections of cold water, IV2 qts. to 
provoke diuresis. 

For coma of neurotic origin, the following enema : 

Tr. Valerian, ^>i ss - 

Musk, grs. xv. 

Yolk of Egg, 1. 

Water, %i. 

Compress the carotid arteries, practice rhythmati- 
cal contraction of tongue and pass the interrupted 
current through different parts of the body. T. 97.) 

Uremic Coma. 
See Uraemic Poisoning. 

*Note;. — The above formula, though outside the province of this 
book, has been given to complete the method quoted. 



136 DIGEST OF EXTERNAL THERAPEUTICS. 

COMEDO. 

(Compare Acne.) 

Wash the parts freely with warm water and soap 
before attempting extraction. The individual comedo 
should be squeezed out with the fingers protected 
with a handkerchief, care must be taken not to bruise 
the skin ; after extraction one of the following may 
be used : 

Sulphur Sublimate: — ^ii with alcohol gi. Apply 
night and morning and allow to remain on. (Kp.) 

Salicylic Acid: — An alcoholic solution, grs. xv &> 
will soften and aid in their removal. (Al.) 

Friction: — Rubbing the skin with green or soft soap 
and water is excellent. Avoid over-stimulation. 

(Ja.) 

The following is useful ; it should be rubbed on at 
night with a piece of flannel : 

Saponis Olivae Prseparatae, 

Alcoholis, aa Ji. 

Aq. Rosae, ^vi. (Ja.) 

Resorcin: — As a lotion or ointment. (B. H.) 
Zinc Oleate: — With 3 per cent, salicylic acid or 
French chalk. (Sm.) 



Thymoli, 


grs. x 


Acid. Borici, 


gii. 


Tr. Hamamelidis Virg., 


sji. 


Aq. Rosae, 


3iv. 


Apply once or twice a day. 





(Sh.) 

Medicated soaps can be used to advantage ; those 
containing Sulphur, Chamomile, Ergot, Salicylic 
Acid or Corrosive Sublimate should be preferred. 



CONDYLOMATA. 137 



CONDYLOMATA. 

Immediate removal with the scissors and cauteri- 
zation of the base with Nitric or Carbolic Acid may 
be practiced in the pedunculated variety. Broad 
growths should be first cocainized, then nitric acid 
applied. After removal and cauterization, use some 
of the antiseptic dusting powders, such as Dermatol, 
Iodoform, Bismuth Subnitrate, etc. Calomel: — Dust- 
ed on with the use of moderate pressure is best for con- 
dylomata with broad flat base, especially when they 
are numerous. (CI.) The parts should first be washed 
with chlorinated soda. 

Tr. Thuja: — For use when the growths are situa- 
ted on glans penis or scrotum accompanying gon- 
orrhoea. (Hg.) 

Labarraque's Solution: — Diluted, recommended for 

warts around labia, followed by calomel, resorcin, 

or burnt alum and savine, equal parts of each. (B.H.) 

Hydrarg. Bichlorid.: — One of the best remedies. 

Bathe the part with a 1—2000 solution and dust on 
the following powder: powdered savine aud pow- 
dered salicylic acid, equal parts. (Vn.) 

Collodion: — In combination with Salicylic Acid 
or Hydrarg. Bichlorid. painted on daily is recom- 
mended. A drachm of either to an oz. of collodion. 
(B.H.) Chloracetic Acid: — An excellent caustic. (Al.) 
Acetic Acid: — One ounce, with Salicylic Acid, half a 
drachm, is a combination preferred by Unna ; the 
mixture is applied twice daily with a camel's hair 
brush. (F.) Chromic Acid ^i 9ii, aq. destill. ,^i, forms 
an efficacious caustic ; the surrounding parts must 
be well protected. (B.) Caustic Lead: — Lead oxide, 
4 grs. mixed with 2 drachms of a saturated solution 



138 DIGEST OF EXTERNAL THERAPEUTICS. 

of caustic potash (100°) forms a caustic which pro- 
duces a black slough but does not penetrate deeply. 
(N.) Contact with the growth for five minutes will 
soften the mass and permit easy removal, after which 
apply an antiseptic dusting powder. 

Nitric Acid: — In addition to its action as a cauter- 
ant, may be used in an aqueous solution, ^i— Oj, for 
bathing the affected surfaces. Under its influence the 
growth will disappear. (B.) 

Euphoren: — An excellent dusting powder. (Sm.) 



CONJUNCTIVA-BLENORRHCEA OF. 

Keep the patient quiet, allowing him to go into the 
open air only at stated intervals. Strictly quarantine, 
and observe great caution in regard to cleanliness 
and the prevention of contagion. ^Ro.) 

Iced Cloths : # — These should be applied to the closed 
lids while in the recumbent position for fifteen or 
twenty minutes continuously, every one, two or three 
hours, according to indications. (Ro.) They are also 
advised to be kept applied continuously as long as 
there is marked oedema of the lids and conjunctiva. 

Nitrate of Silver: — A solution of grs. v-xx— §i, should 
be applied to the palpebral conjunctiva once or twice 
a day by the surgeon while the nurse may use alum, 
grs. ii— ^i. (Ro.) Strong solutions of the nitrate of 
silver should be neutralized by salt solutions. (Bl.) 

Cocaine Hydrochlorate: — A solution of grs.viii— gi 
should be dropped into the eye according to circum- 
stances for the relief of pain when the iced cloths fail 
to relieve. When using this remedy the eye should be 
flooded with it, using 10-30 drops. (Ro.) 



CONJUNCTIVITIS — ACUTE CATARRHAL. 139 

Alum Crystal: — As the swelling of the lids and 
other symptoms subside, this may replace the iced 
cloths and nitrate of silver; the lids are inverted 
and the alum applied by the surgeon. (Ro.) 

Benzoated Lard or Vaseline should be smeared on 
the lids at all stages of the disease after applications. 
(Ro.) 

The absorbent cotton and old linen used in making 
applications, and cleansing the eye, should all be 
burned and the patient's clothing washed apart from 
others. 



CONJUNCTIVITIS— ACUTE CATAR- 
RHAL. 

Boric Acid: — According to Noyes a 1 per cent, so- 
lution is the best local remedy. The following also 
have proved useful : 

Acid. Boric i, 

Sod. Biborat., aa grs. x. 

Aq. Destill., •fj. 

Or, 

Acid. Borici, grs. vi. 

Aq. Camph., ^j. 

Aq. Destill., aa ^j. 

Cocaine Hydrochlorate:— 2 per cent, solution may 
be dropped into the eye at intervals of ten minutes 
until sensitiveness is allayed. This is recommended 
when there is much discomfort from heat, grittiness 
and smarting. Since the remedy has the property of 
causing the blood vessels to contract, it is useful. 
(Ny.) 



140 DIGEST OF EXTERNAL THERAPEUTICS. 

Zinc Sulphate: — 1—2 gr. to the ounce of water is of 
service. (Ro.) 

When the inflammation is of traumatic origin the 
following : 



Or, 
Or, 



Tr. Aconiti, gtts. x. 

Aquae, gj. 

Tr. Arnicae, gtts. x. 

Aquae, ^i. 



Tr. Hamamelidis, 

Tr. Arnicae, aa gtts. x. 

Aq. Destill., ^j. 

Tr. Ledum: — When there is much ecchymosis ten 
drops to the ounce of water. Solutions of Formalin, 
1-2000, and Bichlorid of Mercury 1-10,000, are also 
employed. (Bl.) Alum: — Solution of grs. i— ii— 3j. 
(Ro.) This remedy is condemned by some oculists as 
injurious. (Ny.) Cold Cream or simple Cerate applied 
to the lids is of service. Many cases require no other 
treatment than the boric acid and borax prescription 
above. 

If the inflammation is more severe the following 
will prove useful. Lead Acetate: — 1 drachm with 
infus. of opium, 1 pint. This should never be used 
when there is any tendency to ulceration of the cor- 
nea, as it forms a precipitate on it. It is only useful 
in the early stages and must be applied warm. Liq. 
Plumb. Subacetate: — 2 drachms to water 6 ounces, is 
also employed. Nitrate of Silver: — Grs. ii—^i, dropped 
into the eye may be used daily when there is a large 
quantity of secretion or intense redness or effusion 
which calls for active interference. Tannin : — Gr.sv— ^i, 
suitable when cedematous infiltration is extensive 
and secretion moderate. It is sometimes also useful 
in old people. (Ny.) 



CONJUNCTIVITIS — CHRONIC CATARRHAL. 141 

Hydrarg. Oxid. Flav.: — Grs. ss.— 3J, answers well 
when there are incrustations on the eyelids. Apply 
only at root of the cilia, and do not allow any to 
enter the eye. (F.) Cleanliness is in all cases of the 
utmost importance. 

After subsidence of the symptoms examine for hy- 
permetropia and astigmatism. 

CONJUNCTIVITIS GRANULOSA. 

(See Trachoma.) 

CONJUNCTIVITIS — CHRONIC CA- 
TARRHAL. 

Alum: — 1-2 grs. with 10 grs. of Boric Acid is very 
useful in many cases. A little Morphine may some- 
times be added. Nitrate of Silver: — Grs. ss-gi. Its 
long-continued use will cause an unsightly and irre- 
movable stain; in strong solution, it may cause perma- 
nent ulceration of cornea. It is nevertheless an old 
and well used remedy. Tannin: — Grs. ii— v— §i. A 
few drops in the eye ; or evert eyelid and paint with a 
sol. grs. x— xxx— ^i. Zinc Sulphate: — Extensively em- 
ployed : — Grs. ss— ii— §i. The solution may be applied 
two or three times a day. Wine of Opium: — A drop 
in the eye relieves pain and improves condition of the 
membrane. (Al.) 

CONJUNCTIVITIS— DIPHTHERITIC. 

Atropia or Scopolamine: — To be used from the 
start. (Ro.) Papoyotin: — 1 part with 5-10 parts 
of water and glycerine (not to be" substituted by 
papoid) may be applied every hour. (Jac.) 



142 DIGEST OF EXTERNAL THERAPEUTICS. 

Ice and Cold Applications:— Authorities differ. Ice 
should be persistently applied according to Jacobi. 
On the other hand MacBride says cold applications 
should not be made to any great extent because it 
interferes with the nourishment of the cornea. 
Roosa says hot or cold applications to the closed 
lids as may be most comfortable. Great care should 
be exercised in cleansing the eye, as the slightest 
abrasion of the cornea will allow the membrane to 
form on the denuded surface. 

Hydrogen Peroxide: — 3 per cent, solution recom- 
mended for cleansing ; too strong solutions cause 
haziness of cornea. The secretions should be removed 
every night and cotton dipped in a saturated solu- 
tion of boric acid, and an ointment applied to the 
edges of the lids. (Ro.) Antitoxine Serum is re- 
ported to have been used with success. (T. 96) 



CONJUNCTIVITIS, PHLYCTENULAR. 

Atropia Sulphate: — Instillations of a solution of 
grs. ss— ii— ^i, should be made two or three times a day. 
(Ro.) 

Cold Douche: — If there is much photophobia this 
is very useful ; it is often of immediate service, but 
is a harsh remedy. Cocaine may be substituted, but 
if not effectual, the douche should be employed. (Ro.) 

Gly cerate of Tannin: — Ver}' useful for application 
to the nostrils for the catarrh which is usually pres- 
ent. (Ro.) Calomel: — By insufflation or dusted on 

* Note. — Before applying Calomel to the eye first inquire if the 
patient has been on a course of iodides, for a chemical combination 
may follow which may cause great disturbance. 



CONJUNCTIVITIS — PURULENT. 143 

with fine camel's hair brush is a very valuable appli- 
cation; it should not be employed when there is much 
ciliary irritation, as shown by photophobia, lachry- 
mation, or contracted pupil; these should first be con- 
trolled by atropine. (Al.) Cocaine should be used 
until the acute symptoms, especially the photopho- 
bia, have disappeared. (Ro.) 

Ung. Hydrarg. Oxid. Flav.:— Has been used success- 
fully instead of calomel. A small portion is placed 
between the eyelids and rubbed on. (Ro.) 

Bismuth Loretinate: — Dusted in the eye promptly 
relieves. (T. 97.) 

Pyoktanin: — A solution of 1—1000 acts best in 
cases marked by lachrymation and great congestion 
of the palpebral conjunctiva. Ichthyol: — 1—3 per 
cent, solution has been found very useful. (T.98.) 
Antipyrin:— 2 per cent, solution. (T.98.) 



CONJUNCTIVITIS, PURULENT. 

In the earlier stages mild antiseptic lotions and 
bathing the eye in hot water are indicated, but it is 
usually not until after this period that the patient is 
seen by the surgeon. (N. O.) When the stage of 
secretion has set in, the following remedies "will be 
indicated : 

Nitrate of Silver: — This remedy has more power 
than any other in neutralizing the poison. When the 
secretion and swelling are slight, solutions of 2—5 
grs. to the oz. may be used ; but when there is much 
swelling and secretion, the strength should vary from 
10 to even 60 grs. to the oz. in very severe forms. 
The solution is to be applied to the everted lid with 
a brush and the cornea protected at the time of ap- 



144 DIGEST OF EXTERNAL THERAPEUTICS. 

plication. Salt solution must be added immediately 
to neutralize. (Bl.) These solutions should be fol- 
lowed at once by ice cold applications in order to 
prevent reaction. (N. 0.) 

Formalin:— 1-1000 or 2000 must be used freely 
for bathing the eye. Hydrarg. Bichlorid. — 1—4000 
(Bl.) or 1—5000 or 10,000; or saturated solutions 
of Boric Acid, for cleansing. 

Potass. Permang.: — Grs. iii— x— gi have been highly 
recommended ; they should be applied thoroughly to 
the conjunctiva twice a day in severe cases and once 
a day in mild. 

Ice Cold Applications: — Placed upon the lids are of 
great value in checking the inflammation. They 
should be kept continuously applied, being changed 
as soon as warm, which will be in a minute or two. 
(N. O.) 

The following is a summary of treatment recom- 
mended by Roosa : 

Early Stages. 

1. Cleanse the conjunctival sac as often as the dis- 
charge collects, night and day, with absorbent cot- 
ton, saturated solution of Boric acid or Borax in 
water. 2. Cold applications by Ice Cloths unless 
there is ulceration of cornea. 3. Free use of Vaseline 
to lid and surroundings. 

Later Stages. 

1. Daily application of Nitrate of Silver grs. v— x— 
§i, or every two hours application of a solution of 
4^-q gr. to the oz. in the form of spray until the epi- 
thelium of the cornea is coated. 2. The dropping 
into the eye of antiseptics by an attendant. 

Atropine: — Indicated if the cornea shows signs of 
becoming involved. (Ro.) 



CONSTIPATION. 145 

When only one eye is affected the other should be 
hermetically sealed by the Buller shield or some other 
such device. Prophylaxis from contagion, and isola- 
tion of patient when possible should be strictly en- 
forced. (N. O.) 



CONSTIPATION. 

It should be the rule to go to the closet at a definite 
and regular hour each day irrespective of inclination ; 
the best time is immediately after breakfast, as intes- 
tinal peristalsis has already been induced by that 
meal. Long continued and ineffectual straining 
should be avoided. Persons of sedentary habits 
should take regular exercise, especially outdoors, rid- 
ing, bicycling, tennis and other sports. (Gn.) 

Hydrotherapy: — The cold spinal douche adminis- 
tered while the patient is in a hot bath or the alter- 
nate application of hot and cold water. When there 
is spasm, sedative applications, as flannels wrung 
out in hot water, placed over the abdomen at night 
and covered with oiled silk. (M. N., 12, 10, 98.) 
Cold sitz baths in the morning are also beneficial. 
(Rd.) 

Massage: — General or to the abdomen ; percussion, 
and pounding the abdomen with the inner border of 
the fists in the direction of the ascending and descend- 
ing colon are effective in some cases. (Sj.) 

When the abdominal walls are flaccid and the intes- 
tines atonic, a moderately firm bandage will be of 
benefit, but exercise of the abdominal muscles is much 
better ; this may be performed by forcibly and rap- 
idly retracting the abdominal muscles, repeating the 

movements several times a day. (Gn.) 
11 



146 DIGEST OF EXTERNAL THERAPEUTICS. 

Oil Injections: — From 6—8 ozs. are injected while the 
patient is lying on the left side with the hips elevated ; 
then he lies upon the back and finally on the left side. 
The results are not immediate, but the effect will per- 
sist for three or four days. (M. N., 12, 10, 98.) 

Glycerine: — Injections of a drachm or tw r o ; or gly- 
cerine suppositories are useful. (Gn.) 

Gluten Suppositories: — In mild cases and for chil- 
dren. (Gn.) 

When it is not expedient to give a cathartic, injec- 
tions of Castile soap and water with olive oil may be 
used, especially if there are hardened masses of faecal 
matter. For an immediate effect the following may 
be injected into the rectum : 

Sulphate of Magnesia, ^ii. 

Glycerine, ^ii. 

Turpentine, ^ss. 

Boiling Water, v^iv- 

Inject the entire quantity, and a movement will soon follow. 

This is valuable in abdominal surgery for emptying 
the bowels before operating. In cases of arterio- 
sclerosis and high vascular tension it will reduce the 
latter and relieve distressing symptoms. (Gn.) 

Electricity: — Galvanism ; an insulated rectal elec- 
trode is attached to the negative pole and inserted 
into the rectum, the positive electrode, which should 
be flat and large, is placed over the abdomen. A 
moderate current, not sufficient to produce discom- 
fort, is then applied. It is very important that the 
rectal tube should be insulated ; it should also be hol- 
low so that from four to eight ounces of water may 
be thrown into the rectum. The applications should 
be repeated daily or every other day. (Gn.) 



CONTUSIONS. 147 



CONTUSIONS. 

Rest to the part is important ; this may best be se- 
cured by placing the patient in bed, by Splints, Plas- 
ter of Paris or Bandages, according to the nature 
and location of the injury. Contusions of the back 
may be advantageously treated by the application 
of Rubber Adhesive Plaster cut in strips two and 
one-half inches wide and long enough to extend well 
beyond the contusion. The plaster should be placed 
so as to run in different directions. (W. C.) 

The following are some of the numerous lotions 
recommended for bruises : 

Arnica: — Widely employed. The tincture may be 
diluted with water, 1 part to 10, and saturated com- 
presses applied covered with oiled silk. Hamamelis: 
— Instead of arnica, especially when there is much ec- 
chymosis and the skin is broken, 1 part to 6 of water. 
(Rd.) 

Lead and Opium: — A combination long in use and 
of established merit, viz : 



Tr. Opii, 




Liq. Plumbi Subacetat. Dilut., 


aa ^ii 


Aq. Destill., 


ad. Oj. 



Apply with saturated compresses and cover with 
oiled silk and bandage. (Whar.) 

Alcohol. Dilut., ^iii. 

Liq. Plumbi Subacetat. Dilut., ^i. 

Morph. Acetat., grs. x. 

Apply on a layer of lint and allow to evaporate ; 
this is excellent for keeping down inflammation. 
(Sm.) 



148 DIGEST OF EXTERNAL THERAPEUTICS. 

Opium: — The tincture with Lin. Saponis, one 
drachm to the oz., rubbed in once or twice a day. 
(Wa.) 

Lead:— As Goulard's cerate or the carbonate, viz: 

Plumbi Carbonatis, ^ ss. 

Creosoti, M x. 

Ol. Olivae, q. s. (Sm.) 

Hazeline: — An excellent preparation made of the 
witch hazel twigs as an embrocation. (Sm.) 

Calendula: — 1 part of the succus with about 5 of 
sterilized water, when there is laceration together 
with contusions. (M. H.) 

Capsicum: — A strong tincture mixed with gum 
gives excellent results in removing discoloration of 
the skin. (R.) The following also recommended : 

Tr. Capsici, 

Tr. Myrrhae, 

Tr. Opii, ' aa ^ii. 

Tr. Guaiac, ^i. 

Spts. Camphor., ^ii. (Sn.) 

Aqua Sedativa: — May be applied to painful parts 
on saturated compresses, without friction. (N.) 

Ammonia Chloride: — For contusions of the face 
with much ecchymosis, Agnew recommended Alcohol 
and Water equal parts and the chloride, 5 grains 
to the oz. of this mixture. Or a simple lotion of five 
grains to the oz. Stronger solutions also are used as 
Sii-iv-Oj. (Sm.) 

A good formula is as follows : 

Ammon. Chlorid., grs. xx. 

Tr. Opii, 

Alcoholis, aa gi. 

Aquae, q. s. ad. ^i. 



CONVULSIONS. 149 

Several layers of lint are saturated, applied over 
the contused tissues and then covered with oiled silk 
or rubber. (Whar.) 

Ruta: — 10 drops of the mother tincture to water, 
1 ounce, may be employed as a lotion in place of 
arnica when the latter has a tendency 7 - to produce 
erysipelas, and when the contusion is more of the 
bone than the soft parts. (Rd.) Ichthyol: — Pure or 
with equal parts of water gives good results. (Al.) 

Cold Water: — Bathing the parts in cold water fol- 
lowed by cold compresses. (Rd.) Hot Water: — In- 
stead of cold affords great relief to pain and reduces 
swelling. 

The following liniment appears to be more suitable 
to sprains and bruises combined: 

Ammonia Water, 

Fid. Ext. Arnica, 

Soap Liniment, 

Oil of Turpentine, equal parts. (Sm. ) 

Liniments: — Several are of service and are much 
used for relieving the pain of contusions especially 
when associated with sprains, viz : 

Lin. Chloroformi: — (Tr. Aconit., Chloroform, aa 
gss, Lin. Saponis, §i.) A piece of linen or flannel sat- 
urated with the mixture applied to the painful part 
and covered with oiled silk to prevent evaporation. 
(Al.) Lin. Aconiti, Lin. Belladonnse these two are 
best combined. Lin. Camphor., Lin. Saponis (N.) 



CONVULSIONS. 

General Directions: — Place the patient in the hori- 
zontal position in all cases, give fresh air, loosen the 
clothing, insert a plug of cork or soft wood between 



150 DIGEST OF EXTERNAL THERAPEUTICS. 

the teeth to prevent biting of tongue, and sprinkle 
the face with cold water. 

Epileptic Convulsions: — The same general direc- 
tions as above will usually be sufficient. (Pt.) 

Hysterical Convulsions: — Same as above, but no 
cork in the mouth is necessary as there is no wound- 
ing of tongue. Cold Effusions or Ice Bags on the 
head and inhalations of Ammonia or Camphor. (B.) 

Infantile Convulsions: — Hot Baths with Mustard 
are very widely emplo^^ed and generally recom- 
mended. During the bath an ice bag should be ap- 
plied to the head. In robust children, especially if 
there is colic or abdominal disturbances, these baths 
are likely to prove of service, but if there is reason 
to believe the convulsions are due to cerebral disease, 
or arise at the end of an exhaustive illness, they are 
not advisable and may prove injurious. 

Tepid Baths: — If the temperature is exceedingly 
high (105°— 106°) it is probably the exciting cause; 
place the infant in a tepid bath and pour cold water 
on the head and allow it to run down into the tub 
and gradually lower the temperature. 

Ether or Amyl Nitrite: — A few drops by inhala- 
tion to calm the nervous system and check the 
violence of the spasms. (A. W.) 

Milk of Asafcetida: — May be used freely as an in- 
jection. (Sm.) Leeches to the mastoid process. 
(T. 96.) 

Cold Baths: — A momentary immersion in an ice 
cold bath followed by friction has been found to be 
successful by Anders in obstinate cases, after hot 
baths had failed. Cold Compresses: — Take two 
folded handkerchiefs, dip them in cold water contain- 
ing a little vinegar and envelop limbs as far as the 
knees. (Sj.) 



CONVULSIONS. 151 

Enemata administered to relieve the bowels cons- 
titute an important measure. (Bt.) Chloral and 
Musk: — Simon recommends, after warm enema with 
oil, glycerine or salt has acted, the following clyster: 
Chloral 8 grs. to an infant from 3 to 6 months, 11 
grs. to one 9 months, 15 grs. to a child of one year, 
with 20 drops of Tincture of Musk, giving this in 
three or four parts to ensure retention. (T. 96.) The 
amount of chloral here advised is so largely in ex- 
cess of the usual dose that caution is necessar} T . 

Chloroform: — One of the most effective antispas- 
modics. A few drops may be inhaled. Ruddock re- 
commends one part of chloroform with two of olive 
oil, rubbed in over the spine as a preventive. 

Convulsions of infants a few weeks old who are 
artificially fed are due in a large majority of in- 
stances to indigestion ; a wet nurse or change of food, 
therefore should be procured at once. (A. W.) 

Besides irritation of the alimentary canal and den- 
tition, burns, foreign bodies in the nose and ear and 
hernia, undescended testicle, retention of urine or any 
other external source of irritation should be remem- 
bered as possible causes. 

Puerpural Convulsions : — (See also Ursemic Poison- 
ing.) 

Induction of Labor:— The weight of authority 
tends towards immediate delivery. In general noth- 
ing is gained by endeavoring to protract gestation 
and much is lost. If dietetics and medicinal meas- 
ures have failed, induction of labor should be per- 
formed, this procedure being the best both from the 
standpoint of the mother and of the child. (G. J.) 

When eclampsia comes on suddenly, and when 
urasmic symptoms are increasing, the uterus should 
be emptied as quickly as possible. 



152 DIGEST OF EXTERNAL THERAPEUTICS. 

During the convulsion, the following will be found 
of service while waiting for the uterus to empty: 

Chloroform: — Will afford temporary relief only, but 
time is gained for other measures ; its utility unques- 
tionable when there is no cerebral congestion. (B) 

Morphia: — Hypodermically is a most valuable 
agent, presenting the greatest advantage and fewest 
disadvantages. It should be given in large doses up 
to 2V2 grs. in twenty-four hours. (T. 97.) 

Veratrum Viride: — Very highly praised, can be ad- 
ministered hypodermically ; 26 cases with no deaths 
treated thus and by the mouth, until pulse dropped 
to 60 per minute, are mentioned by Sajous. 

Amyl Nitrite: — Inhalations in cases characterized 
by high arterial tension are of service. (B.) 

Glonoine: — Hypodermically -^ gr. hourly. Same 
indications as amyl nitrite. (G. J.) 

Pilocarpine: — Hypodermic injections ^ gr. were ad- 
ministered in 4 cases ; in 3, convulsions stopped 
quickly and permanently ; it is contra-indicated by 
pulmonary disease. (Sj.) 

Ice to the head and mustard to the feet to relieve 
congestion. (Wa.) 

Venesection: — When the pulse is full and bound- 
ing and when there is much cerebral congestion. 
Chloral: — 40 gr. -doses by rectum. (G. J.) 

JJrsemic Convulsions: — (See Ursemic Poisoning.) 



CORNEA, ULCERS OF. 

Galvano- Cautery: — The serpiginous variety are 
best arrested by a delicate quick touch of the cau_ 
tery, especially in desperate cases. (Mac.) 



CORNEA, OPACITIES OF. 153 

Atropine: — Solution of grs. iv— |i, for adults, half 
this strength for children ; drops are instilled with 
sufficient frequency to maintain mydriasis if there is 
a tendency to iritis. (T. 97.) 

E serine: — One-fifth per cent, solution, 1 drop in the 
eye four times a day to keep the pupil contracted, 
when there is no iritis, for progressive ulcers. (Mac.) 
It is indicated especially in peripheral ulcers with a 
tendency to perforation of the cornea. (T. 97.) 

Hydrarg. Bichlorid.:— Solution of 1-2000; one 
drop in the eye for cleanliness. Brushing the ulcer 
with a solution of 1-1000 will often convert it into 
an active ulcer and lead to repair. (Mac.) 

Hydrogen Peroxide: — Solutions of 3 per cent, may 
be employed in sloughing varieties. (Al.) 

Pyoktanin:— Solutions of 1-1000 claimed by Still- 
ing to give satisfactory results. Other authorities 
less positive. (Al.) 



CORNEA, OPACITIES OF. 

Calomel: — Dusted on every two or three days, pro- 
longing the treatment for some weeks, is effective. 

(F.) 

Ung. Hydrarg. Oxid. Flav.: — This ointment in con^ 
nection with massage has been recommended. (Al.) 

Thiosinamine: — Has remarkable effect in clearing 
up corneal opacities, but should not be used in cases 
in which a vestige of inflammation is still present, 
and which might be started up into fresh phlycten- 
ular. The remedy is employed hypodermically, the 
injection being made deep into the muscular tissues. 
Alcoholic and watery solutions are both employed ; 



154 DIGEST OF EXTERNAL THERAPEUTICS. 

the former is painful, the latter less so and appa- 
rently as effective. The dose varies according to dif- 
ferent authorities ; in the beginning inject V2— 3 A gr. 
twice a week. Hebra has used as much as 4 grs. In 
the prolonged use of the remedy, it has been found 
desirable to suspend its administration for ten days 
every six weeks to two months. (F.) 

Iodine: — 1 to 3 per cent, in vaseline applied to the 
palpebral conjunctiva acts with promptness in su- 
perficial opacities. When vision is impaired from the 
central position of the opacity, and all treatment 
has been unsuccessful, one of the operations for arti- 
ficial pupil must be performed. (Ro.) 

Labarraque's Solution: — In the proportion of 1 part 
to 7—10 parts of water has been highly recom- 
mended for sloughing ulcers ; in the former strength 
it may be applied directly with pledgets of lint ; in the 
latter it may be used as a wash. (Al.) 

Formalin: — A solution of 1-2000 when applied 
freely acts well. Solutions of 1-1000 painted on the 
ulcer every two or three hours retard the ulcerative 
process but are very painful. (Bl.) 

Protective Bandage: — This should be generally used 
but is contra-indicated when there is considerable 
discharge and in young children ; after corneal per- 
foration employ a pressure bandage. 

Scopolamine Hydrochlorate: — Dissolved in vase- 
line or castor oil, is a useful mydriatic in superficial 
ulcers. (T. 98.) 

Iodine: — Of great benefit in spreading ulcers; first 
curette the ulcer then wipe it dry with a cotton 
covered probe and apply iodine thoroughly ; wash 
off the excess with a solution of Formaldehyde, 1- 
1000, the latter being also used as a collyrium dur- 
ing the treatment. (T. 98.) 



CORNS. 155 

Iodoform or Iodol: — In extending ulcers after cau- 
terizing with the galvano-cautery, touching only the 
advancing margin of the lesion ; these remedies finely 
divided are useful for filling in the ulcer. (T. 98.) 



CORNS. 

Salicylic Acid: — One of the most effective remedies. 
It may be applied in the following manner : Satur- 
ated solution in collodion painted on, or moisten the 
part with some antiseptic lotion and dust on the 
powdered acid thickly ; then apply several layers of 
borated lint and bind down with gutta percha or 
some convenient dressing. This should be left on 
for four or five days, then renewed if necessary. 
The plaster mull of Unna consisting of 30-50 parts 
of the acid and 5-10 parts of creosote spread on 
gutta percha. (F.) The following applied once or 
twice a day with a camel's hair brush has been used 
•with great success : 

Acid. Salicylici, gi. 

Ext. Cannabis Ind., grs. x. 

Collodii, gi. (Kp.) 

Yigier's Preparation sold as "Hebra Corn Rem- 
edy" is similar, namely: 

Acid. Salicylici, grs. xv. 

Ext. Cannabis Ind., ' grs. viii. 

Alcohol., M xv. 

Ether., M xl. 

Collodii Flex., M lxxx. 

Paint on three times a day for a week. Then soak the part in 
hot water and the corn can be picked out. (J a 



156 DIGEST OF EXTERNAL THERAPEUTICS. 

Tr. Iodine or Tr. Verat. Viride — Painted on are 
useful for reducing inflammation. (Bt.) 

Calendula: — 20 per cent, solution with Carbolic, 
1-100, is useful in allaying inflammation arising 
from injudicious paring. 

Nitrate of Silver: — Applied in the following manner 
is highly recommended: Soak the corn in hot water, 
then pare down the horny layers and apply a 30 per 
cent, solution. It is claimed that the corn will rarely 
reappear. (F.) 

Copper Oleate: — Melted and spread on plaster will 
soften. (Sm.) Liq. Potassa: — For softening so as to 
permit removal. (N.) Diachylon Plaster, Flexible 
Collodion, Poultices, Plasters of soft material, as 
felt with a hole in the centre, also useful. 

The following are recommended when a caustic 
effect is desired (F.): 

Glacial Acetic Acid, applied by means of a stick. 

Potass. Bichromate, a saturated solution. 

Sodium Ethylate, applied with a glass rod. 

Or, 

Acid. Salicylici, £i. 

Zinc. Chloridi, ^ss. 

Collodii, gi. (F.) 



COUGH. 

Certain drugs administered in the form of lozenges, 
inhalants and cough mixtures have a topical effect 
on the throat and are sometimes useful palliatives. 
Of these the following are recommended : 

Acacia: — Forms the basis of many pastilles, and 



COUGH. 157 

in the form of " gum drops " may allay a cough due 
to retention of mucus on the posterior nares or 
vocal chords. 

Bromide of Potash: — 10-20 grains in an ounce of 
water, used as a spray, forms a good sedative. 

Chloroform: — A few drops on a sponge or in half a 
pint of hot water and the vapor inhaled. 

Cubebs: — 10 drops to half an oz. of water, with a 
small quantity of magnesia carbonate is sometimes 
used as an inhalant. 

Opium and Morphia: — Enter largely into the for- 
mation of cough lozenges, from ^ — to S r - °f mor- 
phia, or y 1 ^ gr. of opium, or the extract of opium, is 
usually in each. Wistar's Cough Lozenges contain 
powdered opium ^ gr., oil of anise -£%, ext. licorice 
lgr. 

Oil of Thymol: — 1 minim, with oil of anise 3 min- 
ims, to half a pint of water and a little carbonate of 
magnesia is useful by inhalation in cases of cough 
arising from dilated bronchi. 

Terebene: — 20 drops on a napkin inhaled daily is 
especially recommended in chronic winter coughs. 

Camphor Chloral:— Painted over trachea is said to 
allay spasmodic cough. 

Tr. Iodine: — Painted on chest affords relief of 
chronic bronchial catarrh. 

Oil of Sandalwood: — 6 minims to 1 ounce of water 
as an inhalant is soothing and may be used in phleg- 
monous inflammation. (Al.) 

Mucilaginous drinks, such as Flaxseed Tea, with 
Marshmallow, lemon, decoction of Iceland Moss, 
Whiskey and Glycerine or Rock Candy. Inhala- 
tions of Steam, Hot Fomentations around throat. 

Troches: — The following of the Pharmacopoeia: 
Tannic Acid, for relaxed throat. Ammon. Chloride, 



158 DIGEST OF EXTERNAL THERAPEUTICS. 

to palliate subacute and chronic inflammation of the 
throat. Catechu, to relieve the huskiness and hoarse- 
ness due to overuse of the voice, and for slight phar- 
yngeal and laryngeal cough. Krameria, same pur- 
pose as tannic acid or catechu. (N.) 

CROUP, SIMPLE CATARRHAL. 

Steam Inhalations: — Water should be kept con- 
stantly boiling in the room, or a tent may be placed 
over the patient and the steam allowed to enter. 
(Gn.) 

Hot Compresses: — Flannels wrung out in hot 
water and applied to throat and covered with oiled 
silk are useful. (Ga.) Cold Compresses:— Applied 
to larynx often effective in the commencement of an 
attack and will relieve many cases. (Gn.) 

Iced Cloths recommended in cases attended with 
much fever. (Ty.) 

Mustard plasters: — As counter-irritants recom- 
mended to be always applied. (Ty.) 

Hot Foot Baths to the knees have a good effect. 
(Ga.) 

The temperature of room should be between 68° 
and 75°. Products of illuminating gas are objection- 
able; gas stoves, therefore, should not be used for 
croup kettles. (A. W.) 

If rhinitis is present it should receive prompt treat- 
ment; the following sprays are suggested for this 
purpose (Pep.): 

Menthol: — 1—2 per cent, in albolene, or 

Cocainse Hydrochlorat., grs. l-ii. 

Acid. Tannic, grs. v. 

Aq. Destill., £iv. 

Qr, 

Hgdrogen Peroxid., £i. 

Glycerin., giii. 



CROUP, MEMBRANOUS. 159 



CROUP, MEMBRANOUS. 

Antitoxin-. — As the vast majority of cases on ex- 
amination show the Klebs-Loeffler bacillus, all are 
suitable subjects for antitoxin. " All cases of laryn- 
geal diphtheria, the patient being two years or more, 
should receive as follows : 2000 units at the earliest 
possible moment ; 2000 units after 12 or 18 hours, 
unless there is improvement, and the same dose 24 
hours after the second dose if there be still no im- 
provement. Patients under 2 years should receive 
1000-1500 units." (Jac.) " Nowhere is the serum 
treatment so effective as in these cases; 1000-2000 
units should be given at once." (T. W.) 

Calomel Inhalation: — Recommended next after an- 
titoxin. (T. W.) Inhalations under a tent of the 
sublimated drug. Use 8—10 grs. every hour or at 
longer intervals. (Jac.) 

Lime: — Slaked under a tent decidedly beneficial and 
very generally recommended, the patient inhaling the 
steam from the slaking lime. (Jac.) 

The following are for constant inhalation from 
boiling water: 

Carbolic Acid, grs. i-iv. (F.) 

Oil of Turpentine, 1-5 drops, with glycerine, gi, 
water, ^i. (F.) 

Lime Water alone or with equal parts of water. 
(L. T.) Not so effective, however, as slaked lime. 
(Jac.) 

Tr. Benzoin Comp., y 2 dr. to a pint of water. 
(L. T.) 

Tr. Iodine or Bromine, a few drops of either in the 



160 DIGEST OF EXTERNAL THERAPEUTICS. 

croup kettle is recommended as sometimes of service. 
(Gn.) 

Cold: — Cold water or an ice bag applied to the neck 
is sometimes preferable to heat, as the inhalation of 
steam is not always as beneficial as it appears. 
(Jac.) There does not seem to be any special indica- 
tion for the use of cold or heat, each case being a rule 
for itself; heat may, however, be said to be most 
generally effective as well as the most grateful. 

Papoyotin: — 1 part to 10 of glycerine and water 
may be applied with a brush or spray ; Jacobi believes 
this drug capable of dissolving membranes ; other 
solvents of this nature were formerly much used. 

Lactic Acid: — In more or less saturated solutions 
has been recommended as a solvent of the false mem- 
branes, applied with spray or brush. For spray a 
4-5 per cent, solution; for the brush somewhat 
stronger solution. (F.) 

The following other remedies are used as sprays : 

Hydrogen Peroxide, 1 part to 8-10 of water. 

Sulphurous Acid, 50 per cent, solution. 

Carbolic Acid, 1 per cent, solution. 

Lime Water, pure. 

Tannic Acid, 5 per cent. 

For other remedies of this nature see Diphtheria. 

Intubation and Tracheotomy. 

The indications for these measures are a small 
rapid intermittent pulse, aphonia, cyanosis, and 
marked retraction of the supra-scapular fossae and 
epigastrium with each inspiration. Either should 
always be performed when the child is suffocating. 

Intubation: — In most instances this has displaced 
tracheotomy. Jacobi says he has not seen a case in 



CYSTITIS. 161 

which it would not take its place ; moreover, it never 
renders the latter impossible. 

Tracheotomy: — May be preferred to intubation for 
the purpose of freeing the trachea of the membrane. 



CYSTITIS. 

ACUTE CYSTITIS: 

Hot Fomentations to the hypogastrium and peri- 
neum, and Hot Sitz Baths should be administered ; 
they are powerful revulsives for abating pelvic con- 
gestion and pain, amelioration being sustained for 
some hours after. 

For the relief of pain, suppositories of Opium 1 
grain, or Opium and Ext. Belladonna, each ^4 gr. 
(Cl.), or 

Morph. Sulph., 
Cocain. Hydrochlorat , 
Ext. Belladonn., 
01. Theobrom., 
Use every 4 hours until pain is relieved. 

Or, 

Ext. Opii Aq., 
Ext. Hydrocyan., 
01. Theobrom., 
Use every hour until relieved. 

Morphia: — Hypodermically, when the suppositories 
of opium constipate. 

Relief of pelvic congestion may be obtained by rest 

in bed, elevation of pelvis with flexion of the thighs 

on the body and the knees supported on a pillow, 

evacuation of bowels, normal cold, saline enema and 

12 



i 



gr- 






1 

6 


g r - 






T2 gr. 
grs. xlvi. 
(T. 


96.) 




. i. 
1 

■ 4* 






gr 


. XV. 


(B, 


H.) 



162 DIGEST OF EXTERNAL THERAPEUTICS. 

counter-irritants over pubes and perineum. Coun- 
ter-irritation may be applied in the form of small 
Blisters and Hot Fomentations, changed every hour, 
are much better, Turpentine Stupes and Mustard 
Plasters may also be employed. (B. H.) 

During the stage of decline, if there is a tendency in 
the disease to become chronic, irrigations of the blad- 
der with mild antiseptic washes, selected with a view 
of avoiding any irritation are indicated, such as the 
following : 

Potass. Permang., 1-2000. 

Creolin, 1-500. 

Acid. Boric, 1-100. (B. H.) 

CHRONIC CYSTITIS. 

Local treatment consists of Irrigation, Instillation 
and Drainage. (B. H). 

Irrigation is of the greatest service in all chronic 
forms. For washing out the bladder, Marcy's 
double catheter with a fountain syringe or Skene's 
apparatus may be used. In performing irrigation it 
is of the greatest importance to exclude the air from 
the bladder ; this can be accomplished by causing the 
patient to retain a small quantity of urine, so that 
when the catheter is passed, preparatory to the wash- 
ing, the urine will pass through and fill it, if the blad- 
der is empty the catheter should be first filled. (CI.) 

The normal bladder, it should be remembered, holds 
from six to eight ounces, but it is rarely admissable 
to inject more than three or four ounces. Injections 
should be made slowly, and the irrigating fluid must 
be at a temperature of 90°-100° F. A few drops of 
a 4 per cent, solution of cocaine may be instilled into 
the urethra when there is much irritability. 



CYSTITIS. 163 

The following mild solutions are recommended for 
their cleansing effect rather than for stimulation : 

Potass. Permang., 1-5000-1-2000. 

Carbolic Acid, 1-500. 

Boric Acid, 1-50. 

Nitrate of Silver, 1-500. 

Normal Saline Solution, 7 per cent. (B. H.) 

Other solutions for irrigation, some of which are 
stronger and stimulating, are as follows (CI.) : 

Potass. Permang., 1-250. 

Hydrogen Peroxide (15 vol.), */£ to full strength. 

Pyre zone, 3 per cent, to full strength. 

Aqueous Hydrastis (Ernesty's), ^i-Oi. 

Bichloride of Mercury, 1-2000 to 1-5000. 

Borax, gi-Oi. 

Boric Acid, si-Oi. 

Sodium Chloride, 3i-Oi. 

Of the above, the borax solution, according to Car- 
leton, is the best. The following are also recom- 
mended 

Nitrate of Silver: — In increasing strengths begin- 
ning with -^ grain to the ounce and running up to 
V4rV2, or even 10-15 grains to the ounce in severe 
cases where strong solutions are needed. (D. H.) 

Nitric Acid: — 1 drop to the ounce in cases where 
the urine is ammoniacal with tendency to phosphatic 
deposit and formation of calculi. (D. H.) 

Guaiacol: — 20 percent, solutions in olive oil; 1 to 
2 grains of the injection twice daily; 1 per cent, of 
iodoform added is said to increase its efficacy. This 
has been found of benefit in relieving the pain and fre- 
quent micturition. (T. 97.) 

The following is recommended by Lutand, of Paris: 

When pain and inflammation have subsided, an 



164 DIGEST OF EXTERNAL THERAPEUTICS. 

elastic catheter, to which a syringe is attached, is in- 
troduced into the bladder and the followiing injected: 

Boric Acid, ^j gij. 

Biborate of Soda, 5 j grs. xv. 

Distilled Water, Oi gxij. 

Of this injection one to one and a half ounces ac- 
cording to the irritability of the bladder, are to be 
injected. This is followed by four and three-quarter 
ounces of warm water holding the following mixture 
in solution : 

Iodoform, 3 vij grs. xlii. 

Glycerine, ^j ^ij. 

Distilled Water, ^ v. 

Gum Tragacanth, grs. iv. (T. 96.) 

The following formula for an irrigating fluid is rec- 
ommended by Dr. Gouley : 

Hydrarg. Bichlorid., grs. v. 

Amnion. Chlorid., grs. xx. 

Spts. Gaulther., ^ss. 

Acid. Boric, ^j. 

Glycerini, J viii. 

To one-half ounce of the solution add 7 ounces of warm water 
(no ) and 2^ ounces of Hydrogen Peroxide. This 10-ounce 
mixture should be sufficient for four washings. 

Nosophen: — 4 per cent, solution said to clear the 
urine in a few days. (Sj.) 

Plumbi Acetas: — 14 gr. to the ounce in warm solu- 
tions regarded by Sir Henry Thompson as one of the 
best mild injections when the urine is alkaline. 

Acetic Acid: — The following combination is recom- 
mended by Sir Henry Thompson for injection afte r 
the use of nitrate of silver : 

Plumbi Acetat, J}ii. 

Acid. Acetici Dil., gvi. 

Acid. Carbolic, ^ss. 

Aq. Destill., |iv. 

1 drachm of the solution is added to 4 ounces of water and in- 
jected once or twice a day. (A. ) 



CYSTITIS. 165 

Creolin: — y 2 per cent, solution has given good re- 
sults in an obstinate case. (Al.) 

Hydrochloric Acid: — When the urine is ven T alka- 
line with large amount of phosphates as is often seen 
in fracture of vertebrae an injection of a solution con- 
taining V2 to 1 minim to the ounce may be used. (Al.) 

Curettage: — Guyon's method for painful cystitis in 
the female (19 cures and 10 failures reported) the 
patient is anaesthetized and the bladder irrigated 
with boric acid or sublimate solution 1-10,000, a 
medium sized Volkmann curette is introduced. While 
the left index finger is pressed against the vesico- 
vaginal septum as a guide, the instrument is moved 
over the mucous membrane carefully in the region of 
the trigone and neck, the usual seat of the disease ; 
the anterior and posterior walls and lastly the ure- 
thra are all curetted. A self -retaining catheter is in- 
serted and continued for fifteen to twenty- days. No 
accident is recorded in the above number of cases. 
(T. 98.) 

Dilatation of the Urethra in the Female: — A large 
percentage of vesical symptoms can be relieved by 
this procedure. (Sj.) 

Instillations:— These are made with an instrument 
called in instillator, which is a silver or hard rubber 
catheter about 18 (French) with a fine canal, to the 
extremity to which a hypodermic syringe of 40 
minims capacity is fitted. In applying, the syringe 
is filled with the selected application, the catheter in- 
troduced until it is within the grasp of the com- 
pressor urethrae muscle, and the fluid injected 
along the membranous and prostatic urethra, and 
into the bladder. Larger syringes may be employ ed, 
holding 1-2 drachms. The solutions used in instil- 
lation are the following : 



166 DIGEST OF EXTERNAL THERAPEUTICS. 

Nitrate of Silver: — 1-5 per cent., especially useful 
in gonorrhceal cystitis. Bichloride of Mercury: — 1- 
6000-2000. Iodoform Emulsion:— 10 per cent. (B.H.) 

Vesical Drainage: — Indicated when in spite of all 
treatment the disease progresses and the danger 
of nephritis is increasing. The simplest and safest 
form of drainage is by the urethra ; this is attained 
by inserting a soft rubber catheter of medium size, 
and retaining it. The catheter should be watched to 
see that the flow of urine is continuous, and changed 
every forty-eight hours. Mild antiseptic solutions 
should be used twice daily for irrigating. (B.H.) The 
other methods for continuous drainage are by peri- 
neal and suprapubic incision. For the relative merits 
of these procedures, see works on genito-urinary sur- 
gery. 

CYSTS. 

Paramne: — Sometimes used to distend the walls of 
a collapsed cyst in order to facilitate its removal. It 
is injected in a liquid state and allowed to cool, thus 
affording better facility for the dissecting of the cyst 
walls. (Al.) 

DANDRUFF. 

(See Pityriasis.) 

DERMATITIS HERPETIFORMIS. 

Washes are usually more grateful than ointments 
for soothing the itching and irritation. The follow- 
ing formulae will be found convenient and useful : 



DERMATITIS, VENENATA. 167 

Acid. Carbolici, ^iii. 

Glycerini, J; i. 

Aq. Destill., Oi. 



Or, 



Ammon. Ichthyol., ^ss— i. 

Ol. Amygdalae Dulcis, 

Aq. Calcis, aa ^i. 

To be rubbed in several times daily and allowed to remain on 
the surface. (Vn.) 

Starch Baths with Bicarbonate of Soda can be used 
frequently. Sulphur: — 311 — ^i , according to Duhring, 
the most valuable of all local applications except in 
the erythematous form, when it proves irritating. It 
should be well rubbed in and not smeared on (Vn.) 

Thiol: — 10 per cent, solutions used twice daily have 
been successful. (Sm.) This drug is similar to 
ichthyol in action but has the advantage of being less 
disagreeable in odor. 

Other remedies recommended are Lassar's Paste, 
Resorcin Ointment, Liq. Carbonis Detergens, gii 
with water ^viii, Calamine Lotion, Liq. Picis Alka- 
linus, and Tar Ointment. (J. A.) 

It is better to begin with the mildest application 
and use stronger as the disease advances. 



DERMATITIS VENENATA. 

Lotio Nigra: — According to Van Harlingen, cloths 
saturated with this lotion kept constantly applied 
give very satisfactory results. White says the 
remedy should not be used over extensive surfaces 
for fear of absorption or, if used, should only be ap- 
plied for half an hour, two or three times a day. 



168 DIGEST OF EXTERNAL THERAPEUTICS. 

Cypripedium:— 1 part in 4-5 parts of water is 
used with success in California. (Boe.) 

Grindelia: — A remedy which has given excellent re- 
sults in the proportion of 2-4 drachms to a pint of 
water. Apply on cloths thoroughly soaked with the 
solution and allow them to become almost dry on the 
skin, then renew ; not keeping them, in other words, 
constantly wet. (Vn.) 

The following is recommended by White for use on 
extensive surfaces in place of the black wash : 

Zinc. Oxidi, ^iv. 

Acid. Carbolici, £i. 

Aq. Calcis, Oi. 

Shake well and sop on as often as desired, or when itching causes 
sleeplessness. (Wh.) 

Zinc Sulphate: — Solution of sss-gi, forms one of 
the best applications. (F.) Apply on cloths every 
hour during day. Washing Soda: — Sometimes noth- 
ing is so effective as this domestic remedy in a solu- 
tion. (Vn.) Aq. Calcis: — Applied with cotton and 
lint kept constantly saturated will afford prompt re- 
lief in many cases. (Ja.) Salol: — 3 per cent, solu- 
tions especially recommended. (M. R. 5, 11, 98.) 

Lead Acetate: — An effective remedy, but should be 
used with caution, if at all, when the skin is broken, 
as its application is then dangerous. It may be em- 
ployed as follows: 



Or, 



L,iq. Plumbi Subacetat., Dilut., i part. 

Aq. Destill., 3 parts. (B. H.) 



Eiq. Plumbi Subacetat., Dilut., 3 i— iii. 

Tr. Opii, gii-iv. 

Aq. Destill., Oi. (Al.) 



DERMATITIS, VENENATA. 169 

Burow's solution modified as follows is said to 
afford particularly good results : 

Eead Acetate, £i. 

Alum, £iii- 

Water, Oi. (M. R. 5, n, 98.) 

Sodium Hypophosphite: — Recommended by Mor- 
row. It may be applied in a simple solution of 6 
drachms to the ounce (Sh) or the following: 

Sodii Hy pophosphit . , 3 i . 

Glycerini, 3 ss. 

Aq. Destill., ad. ^viii. 

This may be applied by lint soaked in the solution 
and held in place by bandages. (Vn.) 

The following will be found of service for children 
with whom it is difficult to use compresses or band- 
ages. It is indicated when the itching is severe and 
the skin is broken : 



Or, 



Tar or Oil of Cade, 31. 

Collodion, ^i. 



Gelatine, ^iv. 

Glycerine, ^ i. 

Water, ^ iv. 



When applications in the form of ointment are de- 
sired, the f olio wing : 



Or, 



Acid. Tannici, 
Petrolati, 




grs. xv. 
|;i. 


Acid. Carbolici, 
Hydrarg. Chlorid. 
Pulv. Amyli, 
Petrolati, 


Mitis, 


grs. x-xx. 
grs. x. 

(Vn.) 



170 DIGEST OF EXTERNAL THERAPEUTICS. 

The latter when there is much itching. (Vn.) 

Europhen: — 10 per cent, in vaseline, after washing 
the parts in a saturated solution of bicarbonate of 
soda. (Sj.) 

Cold Cream, Zinc Oxide Ointment, or Diachylon 
Ointment (half strength), also useful. (Ja.) 

Astringent powders, viz : 



Or, 



Pulv. Zinc. Carbon. Praecipit, 

Amyli Oryzae, aa Si. 



Magnesii Carbon. Levis, 

Pulv. Lycopodii, aa £i. (Vn.) 



DIPHTHERIA 

Antitoxin Injection.— It should be borne in mind 
that the antitoxin serum in the market is of varying 
strength, that of each sample being indicated either 
by the amount required to neutralize a given quan- 
tity of normal toxin (German Method), or by its 
power of counter-acting a unit of toxic strength. 
(T. 96.) 

Dose: — 1500-2000 units for the first injection for a 
child of 2 years in laryngeal stenosis and all severe 
cases, to be repeated in from 18 to 24 hours ; if there 
is no improvement, a third dose after a similar period 
if necessary. 1000 units for first dose for severe cases 
in children under two years and for mild cases over 
that age, repeated if necessary in from 18 to 24 
hours. A second dose is not usually required. The 
dose should always be estimated in units and not in 
the amount of serum. 



DIPHTHERIA. 171 

Quality: — The most concentrated strength of an 
absolutely reliable preparation should be used. 

Time of administration : — It should be adminis- 
tered as early as possible, not waiting for confirma- 
tion of clinical diagnosis by bacteriological culture. 
If the case is seen late, injections should be made, un- 
less it is progressing favorably. (T. 97.) 

Rules of the Pasteur Institute /—For the use of 
Roux's serum : 

Preventive Action: A dose of 1% drachms lasts 
from four to six weeks. 

Therapeutic Action : 1*4— 2V2 drachms for benign 
cases at the onset; 4-6 drachms in serious cases, 
or when they have passed several days, up to one 
ounce or even more in severe cases ; 4-6 drachms 
when breathing is embarrassed may render tracheot- 
omy unnecessary. If improvement is not satisfac- 
tory, inject 2Mr4 drachms more. It is better to inject 
at the onset a dose stronger than necessary, cutting 
short the malady, than to inject weak ones at inter- 
vals. 

For infants under one year, inject 15 minims for 
each month ; for adults, except in extremely severe 
cases, it is not necessary to inject more than 4—6 
drachms for the first time. (Sj.) 

Dosage According to Behring: — According to se 
verity of case 600—1000 or 1500 units; this dose may 
be repeated if the symptoms have not improved 
within a day. (Jac.) Small doses at intervals, ac- 
cording to Behring, are more serviceable than larger. 
When the infection is virulent, 600 units is a full dose. 
(Sj.) 



172 DIGEST OF EXTERNAL THERAPEUTICS. 

Dosage for Im m uniza tion . 

i to 3 months, 50 units. 

3 to 4 " 75 

4 to 6 " 100 
6 months to 1 year, 150 

1 to 2 years, 175 

2 to 4 " 200 
Adults, 400 " (T98.) 

Technique : — The skin at the locality of puncture, 
the syringe, and the hand of the physician should be 
rendered thoroughly aseptic. The injection should 
be made into the loose subcutaneous tissue, and not 
into the muscles ; it should always be injected into a 
part upon which there is no pressure, and in all cases 
a special syringe should be used which admits of 
thorough sterilization each time before use. The 
point of injection should be covered with antiseptic 
gauze or iodoform collodion. 

Local Treatment. 

All authorities agree that local treatment is of the 
greatest importance, and should be commenced im- 
mediately, in order to assist in checking the exuda- 
tion, correcting the foul odors and preventing the re- 
absorption of the poison. The remedies which have 
been recommended for this purpose are, as is well 
known, exceedingly numerous; therefore, only those 
which have met with more general approbation are 
mentioned. The removal of the exudate is exceedingly 
desirable, but all undue irritation of the pharynx by 
instruments, forcible removal of the membrane, or ir- 
ritating applications, have been shown to tend to the 
extension of the diphtheritic exudation and are to be 
condemned. 



DIPHTHERIA. 173 

Hydrarg. Bichlorid.: — Solutions of this remedy are 
of great value. When used in the form of a spra} r , 
care should be taken that it is not too coarse, lest 
an excess be thrown on the surface, and cause in- 
jurious absorption, when applied for a long period. 
(F.) It may be employed as an irrigating solution 
in the strength of 1-3000 or 1-4000 (AL); as a 
spray 1-5000 (Bos.) also 1-2000 to 1-10,000; 
for application with a swab 1—1000, in young 
children with caution. (Pep). A solution of 1—20 
in glycerine has been recommended, preceded by a 
boric acid spray, and applied two or three times a day 
with cotton tampons soaked in the solution. Care- 
fully remove all excess to prevent toxic effects. (Sj.) 

The following is recommended by Pepper when the 
bichloride cannot be used : 

Acid. Carbolici, gtts. xii. 

Liq. Calcis, ^iv. 

Apply with atomizer every half hour. 

Salicylic Acid, in solution of 1-1500 or a saturated 
solution of Boric Acid may be used instead of the bi- 
chloride with very young infants. (Pep.) 

Hydrogen Peroxide: — Of great service to cleanse 
and deodorize, used in various dilutions from one- 
half to one-third. It is especially recommended undi- 
luted as a spray in the laryngeal form of diphtheria. 
This remedy is objected to on account of its property 
of coagulating the soluble albumen of the tissues 
causing pseudo-membranes, which fall off and leave 
surfaces ready for fresh invasion. It is none the 
less valuable. Being non-poisonous it is harmless 
when swallowed, an important factor in the treat- 
ment of young children. 

Potass. Permang.:— 1 grain triturated with one 



174 DIGEST OF EXTERNAL THERAPEUTICS. 

ounce of sugar of milk and gum acacia, blown on 
affected part every two or three hours. Applica- 
tion must be very thorough in order to be effective ; 
the powder should be thrown into every accessible 
part. Before application, the peroxide of hydrogen 
spray must be used, thoroughly cleansing the parts. 
All the froth must be carefully removed before the 
permanganate is applied. This treatment is espe- 
cially recommended by Goodno. It may also be used 
as a gargle for cleansing the mouth, grs. iii-^i. 

Lactic Acid: — One of the best solvents. Mackenzie 
used 3 drachms of the acid to 10 ounces of water, 
to be employed as a spray. It may also be used as 
a gargle, putting sufficient acid in the water to make 
it taste sour. When employed as a spray take care 
to protect the eyes. (B.) Applied topically it is 
highly recommended in 5 per cent, solution, or 
stronger, according to the effect. (Bos.) 

Slaked Lime: — A saucer containing slaking lime 
placed in the room and the fumes allowed to impreg- 
nate the air is especially recommended. It is an old 
and effective remedy. It is claimed to be decidedly 
better than lime water sprays to the throat, which 
are almost without effect. (Jac.) 

Thymol: — After septic coagula are removed, this is 
useful in the proportion of 2—20 grains with 5 grains 
of carbolic acid to the ounce of water. This may be 
employed as a spray or gargle. (Al.) 

Toluol: — Lceffler has used the following combina- 
tion, in which menthol seems to deaden the pain of 
the application : 

Menthol, io grams. 

Toluol, enough to make 36 c. c. 

Absolute Alcohol, 60 c. c. 

Lib. Ferric Chloride, 4 c, c. 



DIPHTHERIA. 175 

Remove the superficial mucus and apply a swab saturated with 
the mixture, pressing it firmly for ten seconds over a given spot; 
repeat this until the whole membrane has been thus treated. 

This treatment, it is claimed, gives good results. 
(T. W.) In a series of seventy-one cases all are said 
to have been saved; in another series treated after 
the second day, out of twenty-six one only was 
lost. (F.) 

Liq. Ferri Perchlorid: — 1 part to 4 of alcohol ap- 
plied under illumination with a probe wrapped in 
cotton; the whole surface of the membrane is touched 
gently with the remedy. Care should be observed 
that the solution is confined to the exudation and no 
injury is done to the parts. This method has some 
strong endorsements. (Bos.) Subsulphate of Iron 
or the Tr. of Chloride of Iron are also used. 

Carbolic Acid in proportion of 15 grains to 1 
ounce of glycerine and water, as a spray ; stronger 
solutions may be used with a swab. (Ty.) 

Iodoform: — Saturated solution in ether, or 5 per 
cent, suspended in equal parts of glycerine and 
water are useful preparations. 

Potass. Chlorate: — A saturated solution as a simple 
wash for the mouth. (Ty.) 

Menthol: — 1 per cent, solution in alcohol, applied 
by painting by means of cotton wool, three times a 
day, has given remarkable effects. (T. 96.) 

Pyoktanin (Blue): — Saturated solutions have been 
employed with encouraging results. Applications 
should be made with a cotton covered probe, and 
spray to every part of the upper respiratory track. 
It should be employed early if possible (Gn.) 

Solutions of this drug are unstable ; keep it in dark 
glass bottles, and renew every eight days. It is in- 



176 DIGEST OF EXTERNAL THERAPEUTICS. 

compatible with corrosive sublimate. 3 per cent, 
solution has also been used. 

Nasal Injections and Irrigations: — These can be 
used to wash the pharynx and tonsils as well as the 
nasal cavity, and to do away with special treatment 
of the throat. This is very desirable, as frequently 
children will not permit the throat to be treated or 
even open the mouth, without force being used and 
consequent injurious excitement and disturbance. 
The following are recommended : 

Bichloride of Mercury, 1-3000 or 4000 (Sj.) or 

1 part with 35 of salt and 5000 of water. Cau- 
tion in regard to swallowing in young children. 

Boric Acid acts as well as the bichloride, §ss— Oj 
(Sj.); it may be used in a saturated solution. Lime 
Water, pure. Carbolic Acid, 1 per cent, with caution 
in giving children lest it be swallowed. Solutions of 
Sod. Hyposulphite. (Jac.) 

Warm Saline Solutions:— Useful for cleansing 
passages, but do not cause the bacilli to disappear as 
quickly as the bichloride does. Plain warm water 
will irritate while alkaline solutions will not. (Sj.) 

Papayotin: — Valuable, according to Jacobi, for dis- 
solving the membrane. May be injected, sprayed or 
swabbed on. It is soluble in 20 parts of water, and 
is used in that strength and stronger, as 1 part to 

2 or 4 of water and glycerine. It may be applied to 
nose and throat or through the tracheotomy tube. 

Trypsin: — Recommended as a solvent in place of 
the above. It acts only when neutral or alkaline. 
The following has been employed : 

Sod. Benzoat., ^i ii. 

Sod. Bicarb., gi iii. 

Trypsin., gi. 

Ol. Eucalypti, £i. 

Eiq. Calcis, Oi. 



DIPHTHERIA. 177 

Or, 

Trypsin., grs. xxx. 

Sod. Bicarb., grs. x. 

Aquae, ^i. 

Make a smooth mixture and apply with a brush or spray. 

Another formula with bichloride of mercury is as 
follows: 

Trypsin, 

Sod. Bicarb., aa £ss. 
Aquae, ^ i. 

Hydrarg. Bichlorid., gr. %. 

Glycerini, ^i. 

Warm this mixture and apply with a brush. When 
the membrane begins to soften, spray every hour 
with peroxide of hydrogen, 1 part to 6. (Al.) These 
solvent remedies were formerly much in vogue but 
have fallen into disuse. (F.) 

Myrrh: — The undiluted tincture has been employed 
with success for painting the throat and tonsils ; 
while for the larynx mixed with glycerine it proves a 
useful inhalation. (Saj.) 

Medicated Steam Inhalations:— Are often of great 
service, and may be used in many instances with ben- 
efit. They may be employed as mentioned under 
pseudo-membranous croup. 

Steam Inhalations: — These are very useful for soft- 
ening the membrane. They are more useful in 
tracheo-bronchial diphtheria than in that of the ton- 
sils. (Jac.) 

Dusting Powders are of doubtful utility, generally 
contra-indicated on account of the local irritation, 
cough and general disturbance caused by their ad- 
ministration. Calomel and perhaps Iodol are excep- 
tions. (Jac.) 
13 



178 DIGEST OF EXTERNAL THERAPEUTICS. 

Among the numerous other remedies are the fol- 
lowing : 

Tr. Iodine, 1-40. Liq. Sodae Chlorinatae, 1-20. 
Sulphurous Acid, 1-10. Condy's Fluid, 1-40. Sod. 
Hyposulphite, 30 grs.-l oz. (Ah) 

Guaiacol and Menthol:— The following has proved 
especially effective as a prophylaxis to be painted on 
the throat and tonsils : 

Guaiacol, io parts. 

Menthol, i part. 

Sterilized Olive Oil, io parts. (Saj.) 

Laryngeal Diphtheria: (See Membranous Croup.) 

Nasal Diphtheria: — This form of the disease is very 
apt to terminate fatally unless very energetic treat- 
ment is adopted at once. The nose should be persist- 
ently and faithfully irrigated or syringed with an 
antispetic solution every hour night and day for one 
or two da} r s. The child should be awakened to have 
the solution applied. It is fatal kindness to permit 
it to sleep. (Jac.) Employ the solutions previously 
mentioned, giving preference to those which are non- 
poisonous, when there is danger of swallowing. 

Sometimes the nostrils are completely occluded by 
the membrane. In this case a passage must be tun- 
nelled with the probe and forceps ; the probe may be 
tipped with cotton and dipped in carbolic acid. Co- 
caine may be used. (Gn.) 

A glass syringe with a soft rubber mounting in 
front is the best for administering the injection. 
When the patient cannot be raised, a nose cup or a 
spoon may be preferred. 

The manner of syringing is very important. It 
should be applied horizontally, and the fluid should 
not come out of the same nostril. 



DYSENTERY. 179 

Absolute quiet is very essential ; all unnecessary 
furniture and all drapery should be removed. When 
possible it is well to change the patient's room to 
prevent reabsorption of the poison. (Jac.) 



DYSENTERY. 

ACUTE DYSENTERY: 

Rest in bed and use of the bed pan is important, as 
frequent risings are injurious. (Gn.) Starch Injec- 
tions with 20-30 drops of laudanum after each 
stool are helpful. Mucilaginous Enemata will often 
allay tenesmus. Opium Suppositories for pain and 
tenesmus. Hot Compresses or a large Flaxseed 
Poultice, containing about half an oz. of mustard, 
often acts satisfactorily. (Bt.) 

Bismuth and Acacia: — Half a drachm of each with 
1 oz. water, injected once or twice daily, according 
to the severriy of the symptoms and retained, is 
of value in tropical forms. (Al.) 

Lysol: — 1 per cent, aqueous solution as an enema. 
(T. 96.) 

Irrigation of the Rectum and Colon: — This is the 
most rational treatment of the severer forms. The 
large intestines of the adult, it should be remembered, 
hold about six imperial pints, but not more than three 
or four should be introduced. (Pp.) 

The method of administering recto-colon irrigation 
is important : the patient should lie on the left side 
without a pillow, with the hips well. elevated ; the 
fluid should be introduced slowly, resting when there 
is an inclination to reject. When pain is experienced 
the injections should be discontinued. The plan is en- 



180 DIGEST OF EXTERNAL THERAPEUTICS. 

tirely safe expect when deep ulcers have formed. 
(Gn.) 

The following are recommended for irrigation : 

Sterilized Water. (Gn.) 

Boric Acid, grs. x-gi. (Gn.) 

Quinine, 1-1000 or 1-5000, used by Osier in the 
amoebic form . ( Gn . ) 

Salicylic Acid, 1-2 per cent. (An.) or 1-300 for 
children. (Al.) 

Bichloride of Mercury, 1-6000. (An.) 

Alum, 3i-0i. (Pp.) 

Tannic Acid, 1-2 per cent. (An.) 

Nitrate of Silver, grs. ss-^i. (An.) 

The irrigations are administered at a temperature 
of 100°— 110° F. though, some of the older writers 
advocated their use cold. The Germans use iced 
water injections. If, on account of the irritability 
of the bowels, large injections cannot be toler- 
ated, as is frequently the case, small ones may be 
substituted, and the quantity increased gradually. 
Previous to administration it is often advisable to 
allay the sensitiveness of the part by small injections 
of a 4 per cent, solution of cocaine or small enemata 
of starch and laudanum. (An.) 

This method of treatment is little called for in the 
types of the disease encountered in this part of the 
country, being more especially indicated in the 
amoebic or tropical varieties. 

Acetate of Lead: — Useful in both acute and chronic 
forms for the relief of tenesmus ; the following may 
be given by injection : 

Plumbi Subacetat., grs. iv. 

Morph. Sulph., grs. ss. 

Aq. Fervid., ^i. 



DYSENTERY. 181 



DYSENTERY. 

CHRONIC DYSENTERY: 

Intestinal Irrigation: — The method of administra- 
tion and the solutions advocated for the acute form 
of the disease are also indicated in the chronic ; the 
reader is, therefore, referred to the preceding article. 

Before use the bowel should be well flushed with 
tepid water and freed from all faecal and other irri- 
tating matter. 

Nitrate of Silver: — Is especially endorsed by many 
writers when there is ulceration of the bowels ; after 
the cleansing enema, inject by means of a long flexi- 
ble rubber tube carried up into the colon, using a so- 
lution of grs.x— xx— Oj. Care should be observed in 
inserting the tube so as not to wound the inflamed 
surfaces. (B.) Another useful solution consists of 
nitrate of silver grs. xx, tr. opii, gtts. xx-xxx, water 
Oij, repeated as required. (Sj.) Stronger solutions 
have been employed. Amelioration follows the third 
or fourth washing, but a course of sixty are said to 
be necessary for a cure. (An.) Sulphate of Copper, 
grs. v— x— 3i, an effective injection for ulceration and 
inflammation of the rectum. (F.) 

Examine the rectum for ulceration. 



DYSMENORRHCEA. 

All cases are relieved by Rest in the recumbent post- 
ure. Hot applications to the abdomen and Hot Va- 
ginal Douches. (K. C.) Scarification of the cervix 
followed by Glycerine Tampons and Hot Water In- 



182 DIGEST OF EXTERNAL THERAPEUTICS. 

jections give good results if persistently employed 
between periods. They are indicated in the congestive 
variety. (T. 97.) 

Galvanism: — Of service in all forms, especially the 
neuralgic. Cleanse the vagina with hot bichloride 
solution, 1—2000, and dip the intra-uterine electrode 
in a stronger solution of the same ; the intra-uterine 
electrode is introduced to the fundus, while the other 
is placed over the abdominal wall. The positive pole 
is used if the uterine canal is patulous and the flow 
too free; when the canal is contracted, the uterus 
small and flow scanty, the negative. The seance 
should last about fifteen minutes, and the strength 
of the current should be from 20-40 milliamperes. 
(KC.) 

Spinal Ice Bag, when discharge is scanty; if pro- 
fuse, Hot Water Bag; during intervals, Hot or Cold 
Sitz Baths. (R.) 



DYSPHAGIA. 

Cocaine: — A very valuable agent for relieving this 
symptom. In the last stages of laryngeal tuberculo- 
sis, a spray a few moments before taking food will 
enable the patient to swallow with comparative 
ease. (Al.) 

The following is recommended by insufflation in- 
stead of cocaine : 

Morph. Hydroclorat. , 

Sac. Lac, aa grs. xx. 

Gum. Arabic, grs. xv. 

Use half a grain before meals. 

The effect is said to last many hours. (T. 96.) 
Menthol: — 10-20 per cent, solution in vaseline as 



DYSPNCEA. 183 

a spray is especially useful in the dysphagia of laryn- 
geal phthisis. (Al.) 

Lactic Acid: — Varying from 10—100 per cent.; 
begin with a weak solution. It is one of the best 
topical applications for laryngeal phthisis with ulcers 
of the vocal chords. Dysphagia is almost always 
lessened and sometimes ceases after its use. Applica- 
tion is usually made with a brush every other day 
at first, then daily ; a burning sensation may be pro~ 
duced which will continue several hours; this may be 
relieved bv 10-15 per cent, applications of cocaine. 
(Al.) 



DYSPNCEA. 

Oxygen Inhalations: — Used when pulmonary and 
cardiac disease is the cause ; often a useful palliative. 

Amyl Nitrite: — Inhalations when of cardiac origin 
with high arterial tension. (F.) 

Ethyl Iodide:— According to See this remedy gives 
prompt and satisfactory relief in the dyspnoea of 
phthisis. (Al.) The frequency of administration will 
depend upon the severity of the case, and the dura- 
tion upon the immediate effects. The average time is 
about four minutes and the frequency about six 
times a day. If vertigo is produced the inhalation is 
too long. 

Dry Cups: — Applied to chest and back give tempor- 
ary relief in acute pulmonary, pleural and cardiac 
diseases. 

Inspiration of Condensed Air: — Beneficial in dysp- 
noea arising from many forms of disease ; namely, 
laryngeal and trachial stenosis, chronic disease of the 
bronchi and lungs in all stages, especiallv the earlier. 
(F.) 



184 DIGEST OF EXTERNAL THERAPEUTICS. 

Ice Water: — Swallowed slowly will sometimes re- 
lieve spasmodic forms. (Wa.) 



EAR-ACHE. 

(See also Otitis.) 

Hot fomentations of Chamomile Flowers, Hops or 
Poppy Heads. (F.) 

Cocaine: — 5-10 per cent, solution very effective. 
(B.) 

Atropine: — Grs. iii— v— §i. One or two drops in ear 
is of value, especially when of rheumatic origin. (Al.) 

Chloroform: — Insufflation of the vapor sometimes 
effective. (F.) 

The following often afford relief ; a few drops on 
cotton inserted into the ear : 

Tr. of Aconite: — Of great value, Glycerine, Ham- 
amelis, Arnica, Oil of Cloves. Opium in the form 
of Laudanum, or Morphine in solution. All these 
remedies should be heated before applying. (Bt.) 

Syringing with hot water at short intervals is 
effective in some cases. (Bt.) 



ECTHYMA. 

Local treatment consists first in getting rid of the 
parasites when present, after which treatment should 
be on general antiseptic principles. Crusts, if numer- 
ous, are to be removed by baths, preferably those 
containing Potassium Sulphuret, or by Starch Poul- 
tices containing Boric acid (see Acute Eczema). The 
parts are then to be cleansed with Sublimate Soap or 



ECZEMA. 185 

Carbolized Lotions or Bichloride of Mercury Solu- 
tions, 1—1000. The lesions are then dressed with an 
ointment of Boric Acid, ^i, or Calomel, grs. xv., to 
Zinc Oxide Ointment, ,^i. (Vn). 

A compress soaked in Boric Acid Solution may be 
applied to the lesions and covered with rubber tissue. 
(B. H.) 

Salicylic Acid: — 5-10 grains to the ounce of oil or 

ointment base acts well. (Ja.) 

Ung. Hydrarg. Ammon. — ^i, with Ung. Zinc. Oxid., 
3i, forms a good antiseptic ointment, or grs. v— x with 
cosmoline. (Kp.) 

Carbolic Lotions: — When ulcers show little ten- 
dency to heal, a weak carbolized wash may be used. 
(Kp.) 

Ung. Hydrarg. Ammon.: — 20 grains with zinc 
oxide ointment, 1 ounce (Ja.); or 5—10 grains with 
cosmoline, 1 ounce, forms an excellent antiseptic oint- 
ment. (Kp.) 

Aristol, Permatol, Iodoform, Iodol, and remedies 
of that class in the form of ointments are all service- 
able. 

Cod Liver Oil: — May be used externally. (F.) 



ECCHYMOSIS. 

(See Contusions.) 

ECZEMA. 

ACUTE and SUBACUTE ECZEMA: 

Applications should be of a soothing, sedative char- 
acter, in the more acute forms ; and slightly stimulat- 



186 DIGEST OF EXTERNAL THERAPEUTICS. 

ing in the subacute ; dusting powders, lotions, and 
ointments are employed. When a remedy is applied 
for the first time in acute eczema it is better to use it 
over a limited area, and thus ascertain its effects; for 
what has suited one case will not answer necessarily 
for another with the same apparent characteristics. 
Linen or muslin used for dressings should be disin- 
fected before each application, and care observed that 
there are no creases or folds when laid on the surface. 
It should be of the thinnest, softest variety, and if the 
patient is sensitive to c®ld a fold of flannel may cover 
the dressing. (Vn.) 

Starch Poultice : — One of the best moist applications. 
Potato starch is preferable ; it should be mixed with 
5—10 parts of boric acid per 1000, placed in a flat 
bag, dipped in boiling water and allowed to cool be- 
fore applying. In some cases the starch may be 
made into a paste and covered with very fine linen 
carefully adjusted. No form of treatment, according 
to Van Harlingen, gives more relief in acute eczema 
if carefully applied and changed every six hours. In 
mild cases, or in the later stages, the parts may be 
covered with a few turns of a soft linen bandage 
which has been impregnated with a decoction of bran 
or starch water. (Vn.) 

Dusting Powders : 

These are of service for the redness, vesication, pus- 
tulation, and serous exudation — they may be bland, 
astringent or sedative. 

Corn Starch, Arrowroot and Rice are the most 
soothing; Magnesium, Zinc Oxide, Bismuth and 
Lead Carbonate the most astringent and sedative. 
.(Sh.) 

Corn Starch: — Should be applied at first on all 



ECZEMA. 187 

large surfaces and the parts then covered with linen. 

Zinc Oleate: — 1 drachm with powdered arrowroot, 
1 ounce, indicated when a mild astringent is desired. 
(Sh.) 

Lycopodium, Kaolin, Subnitrate of Bismuth, Der- 
matol and Talc, each alone, or associated, are useful 
for isolated patches. (Vn.) 

When itching is very severe and obstinate 

Camphorae, 5 SS - 

Zinc. Oxidi, ^ii. 

Amyli, 3iv. (Ja.) 

In acute vesicular or erythematous forms water, 
according to most writers, is irritating; it should, 
therefore, only be employed for the requirements of 
cleanliness. Olive Oil has been recommended as a 
substitute for water. Pustular eczema requires 
washing with soap and water at intervals. 

Lotions: 
Lotio Nigra: — Thefollowing is recommended for the 
acute vesicular variety, and constitutes one of the 
best forms of treatment for the majority of cases in 
the early acute stages : The affected part is bathed 
with the lotion, full strength or diluted with equal 
parts of lime water, and covered with cloths satur- 
ated with the same. The following which clings to 
the skin may be substituted for use on the face : 

Hydrarg. Chlorid. Mitis, 3 SS - 

Mucil. Tragacanthae, %i. 

L,iq. Calcis, %yd. 

After the wash has been applied some minutes rub on oxide of 
zinc ointment, or this, 

Pulv. Zinc. Oxidi, grs. lxxx. 

Ung. Aq. Rosae, 

Vaselini, aa ^iv. 

Apply gently with the fingers. The treatment is repeated at in- 
tervals of a few hours. ( Vn. ) 



188 DIGEST OF EXTERNAL THERAPEUTICS. 

Lotio Flava: — May be used with the same indica- 
tions as lotio nigra. (Sh.) 

Liq. Plumbi Subacetatis Dilutus :— Useful in various 
forms ; a pint with half an ounce of glycerine, or with 
laudanum, two ounces of each to a pint of water. 
When there is a good deal of inflammation, and the 
skin is oedematous, a bread poultice mixed with ice 
cold lead water has a soothing and grateful effect. 
(Vn.) 

Compound Zinc Oxide Lotion: — This remedy, also 
called Startin's Lotion, has the widest range of appli- 
cation ; it is as follows : 

Zinc. Oxidi, ^§ss. 

Pulv. Calaminae Prseparat., ^iv. 

Glycerini ^i. 

Liq. Calcis, ^ vii. 

Grindelia Robusta: — Suitable for the treatment of 
large surfaces, half an ounce of the fluid extract to 
a pint of water. Apply with cloths and allow to 
remain on until quite dry. (Vn.) 

Carbolic Acid: — One of the most effective antipruri- 
tics, though rarely adapted to the acute stage ; but 
when itching is intense and burning is not a promi- 
nent symptom it may be used with good effect either 
as a simple lotion in the strength of a drachm to a 
pint of water (Sh.), or in combination with black 
wash, as follows : 

Acid. Carbolici, 3ii~i v - 

Glycerini, %i. 

Lotio. Nigrae, Oj. 

These applications are more adapted to the erythe- 
matous varieties, when the skin is Unbroken and there 
is inflammatory infiltration. (Vn.) In these condi- 
tions weaker solutions of carbolic acid will also give 
good results. 



ECZEMA. 189 

Glycerine: — Alone will prove irritating, but diluted 
with three parts of water will form an agreeable ap- 
plication. (Vn.) 

Zinc Sulphate: — Grs. xv— xxx-^i, sometimes very 
useful for application on the hands. (Vn.) 

Cloths wrung out in Hot Water and applied very 
hot in quick succession will often allay the itching 
when other remedies have failed. 

Alum: — In the form of Burow's Liquor, is useful. 
When there is intense oedema and loss of serum, to 
the extent of causing weakness, use 5—10 parts with 
100 of water on compresses, renewing every three 
hours. (Kap.) 

Boric Acid, Sodium Carbonate, Sodium Hyposul- 
phite and Sodium Sulphite, all in the proportion of 
one drachm to a pint of water, are also used as lo- 
tions. 

Nitrate of Silver: — Sometimes a solution of 3—10 
grains to the ounce painted on moist patches will act 
satisfactorily . ( Ja . ) 

Ointments. - 

As a rule, ointments do not agree with acute 
eczema as well as lotions, yet there are cases in which 
they are preferable. Cold Cream, Cucumber Cream, 
alone or with arrow root, and Glycerite of Starch are 
the most bland. 

Zinc Oxide: — si— Biv, with cold cream ^i, is very 
soothing, and better than the ordinary zinc oint- 
ment, which is apt to be too hard. (Sh.) 

Ung. Zinc. Benzoat:— This is one of the best reme- 
dies after the acute stage (Ja.), though disapproved 
by some writers. (Vn.) 

Lassar's Paste (see Appendix II). — Indicated when 
there is much discharge, as in pustular and weeping 



190 DIGEST OF EXTERNAL THERAPEUTICS. 

eczema. 10—15 grains of salicylic acid may be added 
to increase its antipruritic effect. (Ja.) 

Diachylon Ointment:— This should be prepared 
with great care, as improperly made it is harmful. 
The method of preparation is as follows : Olive oil 
£xv, powdered litharge siii— vi, water a sufficient 
quantity. The oil is to be mixed with one pint of 
water and heated by a steam bath to boiling, the 
finely powdered litharge is sifted in and stirred con- 
tinually ; the boiling is to be continued until the min- 
ute particles of the litharge have entirely disap- 
peared. During cooling, a few more ounces of water 
are to be added from time to time, and when com- 
pleted water will remain in the vessel. The mixture 
is to be stirred until cool. When properly prepared, 
the ointment should be yellowish gray and of the 
consistency of butter. It is best applied on cloths 
and covered with oiled silk for cleanliness. (Vn.) 

Menthol: — 5—20 grains in an ounce of zinc oint- 
ment is useful to allay itching. (Al.) 

Alumnol: — 10—20 per cent, ointments are recom- 
mended by Bulkley. 

The following forms an excellent soothing applica- 
tion: 

Zinc Oxide, 3^j- 

Salicylic Acid, grs. x. 

Starch, ^ii. 
White Vaseline, ^iv. (Kp.) 

Zinc Oleate: — Combined with equal parts of olive 
oil, or with equal parts of ung. aq. rosae with a 
little almond oil, is often valuable. (Vn.) 

Bismuth Oleate: — The following, known as McCall 
Anderson's Ointment, is an elegant combination : 

Bismuth. Oxidi, 3i. 

Acid. Oleici, %i. 



ECZEMA. 191 

Cerae Albse, ^iii. 

Vaselini, 3i x - 

Ol. Rosae, M ii. (Vn.) 

Bismuth Subnitrate: — .\s a mild astringent and 
sedative is especially valuable in acute eczema of the 
scalp in children, as follows : 

Bismuth. Subnitrat., ^ss— i. 

Ung. Aq. Rosse, . %i. (Vn.) 

Salicylic Acid: — In strengths varying from 2—20 
per cent., with lanolin, vaseline or water, is satisfac- 
tory in subacute erythematous varieties when con- 
fined to small areas. This remedy is also effective in 
weak solutions in vesiculo-pustular forms, but its 
best results are seen in eczema rubrum and eczema 
squamosum when there is considerable Assuring. (F.) 

Xeroform: — A 10 per cent, solution will check the 
discharge in eczema madidins and impetiginosum. 
(F.) 

Picric Acid: — Saturated solutions painted on the 
part have been highly praised in acute and subacute 
eczema. (T. 98.) 

Potass. Permang.: — 1—2 per cent, or stronger solu- 
tions have been recommended by Bulkley in patches 
of subacute forms. 



The 


In Eczema 
following will prove 


Intertrigo. 
: useful : 








Bismuth. Subnitrat., 
Zinc. Oxidi, 
Pulv. Amyli, 
Acid. Carbolici, 
Vaselini vel. Ung. Aq. 


Rosse, q. s. 


ad. 


3iv. 

3ii. 

M v-xv. 
Si. (B. 


.H.) 


Or, 


Thymol., 

Pulv. Zinc. Oleatis, 








gr. i. 

El 


(Ja. 



192 DIGEST OF EXTERNAL THERAPEUTICS. 

Or, 



Acid. Salicylici, 


grs. 


Pulv. Amyli, 




Bismuth. Subnitrat., 


aa 5iii 


Ung. Aq. Rosse, 


q. s. ad. ^i. 



(B. H.) 

CHRONIC ECZEMA: 

In some cases the treatment employed for the acute 
form will also be applicable to this type of the dis- 
ease, but as a rule more stimulating remedies will be 
found necessary. 

Tar: — This remedy is largely employed. It is indi- 
cated in the squamous form, and when the disease 
has become decidedly chronic with more or less infil- 
tration. If applied when not indicated it will irritate 
and retard recovery. Mild preparations should be 
used first and increased in strength as indicated. The 
two forms of tar commonly employed are Pix 
Liquida and Oleum Cadini. The following formulae 
are suggested: 

01. Cadini, gss-i. 

Zinc. Oxidi, ^ss-i. 

Ung. Aq. Rosse, %i. 



Or, 



Ol. Cadini, ^i. 

Ung. Zinc. Oxid. Benzoat., ^i. 



Pix liquida may be substituted in the above for the 
oleum cadini in double the strength. (Ja.) 

Oleum Rusci: — Effective but is difficult to obtain. 
It may be used in the proportion of 1—2 drachms to 
the ounce of Ung. Aq. Rosae. (B.H.) Another excel- 
lent way in which to use tar is that of the strong 
tincture, 2 parts to 1 of alcohol. Paint the diseased 
surface with about three coats, allowing each coat to 
dry before the other is applied; then cover with oxide 



ECZEMA. 193 

of zinc ointment, which should be changed every 
morning. (Ja.) 

The following is recommended in old patches to be 
rubbed in with a mop : 

Picis Liquid., 

Sapo. Virid., 

Alcohol., p. e. (Vn.) 

In very chronic thickened varieties tar has been rec- 
ommended to be used pure, dissolved in olive oil if the 
lesions are extensive. Caution must be observed lest 
poisonous effects be produced. 

Compound Tincture of Mineral Tar (Coal tar, 1 
part digested with 6 parts of tincture of quillaia, 
with frequent agitation for not less than eight days, 
preferably longer; then filtered): — This is an excellent 
preparation in which to employ tar in a liquid form, 
especially in dry eczema of the scalp in adults. It 
should be used in the strength of 3—20 minims to the 
ounce of water. (T. 98.) 

Tar Baths: — Are advised by Lassar for the purpose 
of disinfecting the skin ; after the bath the surface is 
dusted with Venetian talc. (T. 97.) 

Wilkinson's Ointment: — Advised by Lassar in ob- 
stinate forms. It consists of equal parts of sulphur 
and oleum rusci, 1 part; prepared chalk V^ part; soft 
soap and vaseline, 2 parts. (T. 97.) 

Carbolic Acid: — A very valuable agent, especially 
serviceable as an antipruritic. It will often allay 
itching when other remedies have failed, and may be 
used in the form of an ointment : 5—20 grains to the 
ounce of base, either benzoated lard or zinc oxide 
ointment. (Vn.) 

Thymol: — An ointment of 10 grains to the ounce 
and upward is used. (F.) 

14 



194 DIGEST OF EXTERNAL THERAPEUTICS. 

Thioform: — 10 per cent, salves are strongly recom- 
mended in moist forms. (T. 96.) 

Sulphur: — A very useful remedy, especially when 
the surface is moist. It is indicated in pustular 
eczema of the hands, in chronic eczema rubrum occur- 
ring in patches, and when it is desired to renew the 
epithelium of the skin by its cornifying powers. It 
may be employed in the strength of 1—2 drachms to 
the ounce of vaseline or cold cream, but should be 
used mild at first and gradually increased in 
strength. A combination of sulphur and tar has 
good effect in old chronic cases attended with much 
itching and infiltration. (Vn.) It is regarded by 
some writers as next to tar in efficacy, forming one 
of the best stimulating remedies. It is not, however, 
as reliable, and in some persons causes considerable 
dermatitis. 

Sapo Viridis: — Often of the greatest service, espe- 
cially in eczema rubrum of the leg and other parts 
where there is extensive infiltration. It should be 
rubbed in thoroughly by means of a piece of flannel, 
until there is considerable smarting and copious se- 
rous discharge. The soap is then washed off with 
warm water, the parts well dried, and a soothing 
ointment, such as diachylon, applied. The procedure 
is repeated daily, and is effective in this form of the 
disease. (Vn.) 

Lassar's Paste: (see Appendix II. for formula.) — 
May be useful in some cases but is better for the 
acute. 

Vasogene or Oxygenated Vaseline: — Made by boil- 
ing vaseline with 4 per cent, of nitric acid, washing 
away the excess of acid and cooling, has given very 
satisfactory results in dry and weeping eczema. (T. 
98.) 



ECZEMA. 195 

Salicylic Acid, Salol or Resorcin: — In strength va- 
rying from 20—60 grains to the ounce of ointment 
base, useful when there is more infiltration than in- 
flammation. (T. 98.) 

Bassorin Paste: 

Bassorini, 5 x. 

Dextrini, gvi. 

Glycerini, sjii. 

Aquae, q. s. ad. ^xxvss. (B. H. ) 

Ichthyol: — Varying strengths are used to reduce 
the thickening in old cases. (F.) 

Thiol: — As a substitute for ichthyol, to which it is 
very similar but free from odor, 2-15 per cent, oint- 
ments, and 50 per cent, solutions. (T. 96.) 

Resorcin: — 2—5 per cent, ointments are useful as 
mild stimulants in lotions or ointments. For ery- 
thematous eczema the following : 

Resorcini, grs. x-xv. 

Glycerini, M x. 

Liq. Calcis, ^i. 

Apply to the part three or four times daily until itching and 
burning cease, and the inflammation lessens. (T. 98.) 

Caustic Potash: — 10-40 grains to the ounce may 
be advantageously employed in old infiltrated cases 
and in eczema of the palms. The application should 
be mopped on, the parts then bathed with cold water 
or covered with cold water compresses, and after 
a while with soothing ointments. This procedure is 
heroic as well as effective, and must be used with 
care. It should never be used more than once or 
twice a week, and never intrusted to the patient for 
applicaiton. (Vn.) 

A preparation introduced by Bulkley called Liq. 
Picis Alkalinus is the following: 



196 DIGEST OF EXTERNAL THERAPEUTICS. 

Picis Liquidse, £ii. 

Potass. Causticae, £i. 

Aq. Destill., 3 v. 

This is to be diluted with from two to eight parts of water. 

(B. H.) 

Mercurial Ointments: — Valuable when the disease 
is limited, but should not be used over extensive areas 
for fear of absorption. 

Some of the preparations in use are as follows : 

Hydrarg. Chlorid. Mitis, grs. x-xxx. 

Ung. Zinc. Oxidi, 

Ung. Petrolei, aa Jss. 

Or, 

Hydrarg. Oxid. Rubr., grs. v-xxx. 

Vaselini, ^i. (Vn.) 

Rubber Protective: — For the reduction of infiltra- 
tion and the removal of scales, nothing is better for 
a limited period. A piece of rubber is applied to the 
part, and bound down with a roller bandage. It 
should be removed once a day, sponged with a solu- 
tion of soda in water and reapplied . This plan affords 
great relief to the itching. As soon as infiltration is 
reduced the tar remedies are indicated. (Ja.) Mar- 
tin's Solid Rubber Bandage is of great service in va- 
ricose eczema rubrum. The bandage should be worn 
during the day only, and on removing at night the 
limb should be bathed in hot water, dried and dusted 
with starch powder, and loosely covered with linen 
for the night. (Yn.) 

Ihle's Paste: — A well known and useful applica- 
tion is the following : 

Resorcini, grs. x-xx. 

Zinc. Oxidi, 

Pulv. Amyli, 

Eanolini, 

Vaselini, aa ^ii. (B. H.) 



ECZEMA. 197 

Plasters: — The mull and salve plasters of Unna be- 
ing now obtained in this country can be used with 
good effect. They^ are, however, expensive and liable 
to become rancid. A substitute in eczema is 

Pick's Salicylated Plaster : 

Emplastri Saponis 3 iiss. 

01. Olivse, 3 v. 

Acid. Salicylici, grs. xxxvii. 

Duhring recommends for a 5 per cent, plaster : 

Emplastri Saponis, £ j. 

Ol. Olivse, 

Acid. Salicylici, aa grs. xxiv. 

For a 10 per cent, plaster, omit the olive oil. 

Hardaway uses lead plaster 61 parts, powdered 
soap 4 parts, and water sufficient to form a paste 
with the soap. Add the lead and evaporate to 
proper consistency. Then add vaseline 30 parts, sal- 
icylic acid 5 parts, and mix with gentle heat. The 
salicylic acid may be increased if necessary. 

These plasters are especially indicated in infiltrated 
varieties of eczema. After the thickening has been 
removed, the salicylic acid may prove injurious, in 
which case it should be replaced by simple ointments 
or pastes. (B. H.) 

Gelatin Preparations: — These were recommended 
by Pick as a vehicle for other remedies and as a pro- 
tective. The following are among the best of the 
numerous formulae (Pick's Gelatin) : 

Gelatinse, giv. 

Zinc. Oxidi, 3 iiss. 

Glycerini, % ss. 

Aquae, 3 vi. 

Heat the water, dissolve the gelatine in it, then add the glycerine 
and zinc; stir until cold. 



198 DIGEST OF EXTERNAL THERAPEUTICS. 

For use the liquid jelly is heated in a hot water 
bath and painted on. One-half per cent, of ichthyol 
or any other remedy used in disease of the skin, ex- 
cept lard, may be added if desired. (B. H.) 

Gelanthum: — Introduced by Unna and modified by 
Skinner, this is as follows: 

Tragacanthae, ^iiss. 

Gelatin. Opt., 3 ii. 

Glycerini, . £vi. 

Thymol., gr. X- 

Aq. Destill., q. s. 

Place the tragacanth and glycerine in a covered jar containing 
ten ounces of water and add enough to make twelve ounces. 

(B. H.) 

Jamieson's Gelatine : 

Gelatine, 15 parts. 

Zinc Oxide, 10 parts. 

Lard, 10 parts. 

Glycerine, 65 parts. 

Heat together in a hot water bath, and add 2 per cent. Salicylic 
Acid. Apply with a brush. (Vn.) 

Pigments: — Various remedies are added to collo- 
dion or liquid gutta percha, thus constituting a pig- 
ment. In small thickened patches of eczema Salicylic 
Acid and Chrysarobin, of each 5—10 per cent., are 
valuable, and in eczemas about the mouths of children 
Tar similarly combined is often useful : 

Ol. Cadini, ^i. 

Collodii (vel. Traumaticini), £i. (B. H.) 

ECZEMA IN CHILDREN: 

Treatment is generally on the same lines as that for 
adults. When the face is the seat of the disease, it 
should be covered with a light linen mask held in 



ECZEMA. 199 

place by being fastened to a skull cap. The oint- 
ments should be spread on cloths and the mask put 
on over them. Suitable openings must be made for 
the nose, mouth and eyes. 

All parts of the skin which are in apposition should 
be kept separated by folds of lint. Scales should be 
removed as directed for eczema of the scalp, after 
which the selected remedy may be applied. 

Kaolin, Zinc Oxide, Bismuth Subnitrate are suita- 
ble dusting powders for the erythematous variety; 
Starch may also be used, but boric acid must be 
added to prevent caking and consequent irritation. 

Black Wash and Dilute Lead Water are often of 
service. 

Boric Acid, in powder or an ointment, 1 drachm to 
vaseline 1 ounce. (Vn.) 

For obstinate cases of the scaly type : 

Tar, 

Alcohol, 

Green Soap, equal parts. 

Or, 

Oil of Cade, i part. 

Olive Oil, i part. 

Lanolin, io parts. 

Or, 

Zinc Oxide, I part. 

Ammonia Hydrate, I part. 

Oil of Almonds, I part. 

Tar, i o parts. (Jac.) 

The following are for use in the vesicular and vesi- 
culo-pustular forms : 

Pulv. Zinc. Carbonat., 3*- 

Ung. Cucumis, 3*- 



Or, 



Bismuth. Subnit., 3*- 

Ung. Aq. Rosae, §i. (Vn.) 



200 DIGEST OF EXTERNAL THERAPEUTICS. 

Balsam of Peru: — 1-30 in A^aseline; apply at 
night. (T. 96.) 

In mild chronic conditions : 

Picis Liquidae, ^ss. 

Pulv. Zinc. Oxidi, ^ss. 

Ung. Aq. Rosae, ^i. 

Or, 

Sulphur. Praecipit., ^ss-i. 

Picis Liquidae, ^ss-i. 

Ung. Zinc. Oxidi, £ i. 

Ol. Cadini, 5j. 

Collodii, %i. (Vn.) 

Nitrate of Silver: — 10—40 grains to 1 ounce gives 
good results in chronic cases of the squamous and 
crustaceous variety. (Jac.) 

The nails should be kept cut short in order to pre- 
vent scratching. 

ECZEMA OF REGIONS. 

Eczema of the Anus. 

The treatment is generally the same as that of the 
infiltrated variety in other localities. The parts 
should be washed with Ichthyol or mild Sublimate 
Soap, and the following applied : 

Acid. Boric, 3*- 

Cocainae Hydrochlor. , 3*- 

Lanolini, %i. (Vn.) 

Tar or Diachylon ointments may be applied, and 
covered with dusting powder. (Ja.) 

A formula for a tar ointment to be preceded by a 5 
per cent, application of cocaine for the relief of the 
pain, is as follows : 





ECZEMA. 




Picis Liquidse, 




3i 


Medullae Bovis, 




3vi. 


Cerse Albae, 




3i- 


Ol. Rosae, 




M v 



201 



(Vn.) 

Salicylic Acid: — A 15 per cent, solution to 1 ounce 
of flexible collodion is often followed bv good results. 

(Ja.) 

Hot Water: — Bulkley recommends the following: 
A soft cloth dipped in water as hot as can be borne 
is pressed against the anal region for a minute, and 
repeated three times ; then dry and apply the follow- 
ing ointment : 

Zinc. Oxidi, ${. 

Pulv. Amyli, 5*i- 

Ung. Picis Liq. , tyi- 3 iv. 

Ung. Vaselini Plumbici, q. s., ad %i. 

Before using the fomentation the salve is made ready for appli- 
cation by spreading it on lint. 

Duhring uses this formula : 

Sulphur. Praecipit., 9ii. 

Naphthol. , 9i. 

Morph. Sulph., grs. ii. 

Zinc. Carbonat., £i. 

Ung. Aq. Rosae, ^i. 

Carbolic Acid: — 20 per cent, in almond oil rubbed 
in with the fingers at night will give relief even when 
the surface is fissured and abraded. (Vn.) 

Rubber Sheeting or protective worn in the form of 
a T bandage for a few days will be useful when there 
is much infiltration. (Ja.) 

Penciling with solutions of Nitrate of Silver, and 
applications of Potash or Coal Tar, may also be em- 
ployed in the same condition". 

Scarification is sometimes effective in exceedingly 
obstinate cases. (B. H.) 



202 DIGEST OF EXTERNAL THERAPEUTICS. 

The parts should be kept as clean as possible, and 
the fold of the nates separate by a layer of lint. 

Eczema of the Auditory Meatus. 

Accumulations of wax and epithelium should be re- 
moved by syringing with warm solutions of Borax 
or Carbonate of Soda as directed under the head of 
Impacted Cerumen. 

Hydrogen Peroxide: — Recommended for cleansing. 
(T. 98.) 

Boric Acid, by insufflation, Tannic Acid gi— ^i„ or 
Nitrate of Silver grs. x— xx— §i applied by means of 
absorbent cotton on a probe, with the ear properly il- 
luminated, are useful to allay the itching. (Bac.) 

Potassa: — When there is much infiltration, a solu- 
tion of 10 grains to the ounce may be applied with a 
camel's hair brush carefully stripped of all excess of 
the solution before introduction, so that not a drop 
will run down to the tympanum. (Vn.) 

Cold Cream: — Is useful after application of nitrate 
of silver if there is much oozing. (Bac.) 

Ichthyol: — 25 per cent, ointments in acute and 
erysipelatous varieties. (T. 98.) 

Calomel: — Grs. v— x— ^i as an ointment in dry and 
irritable forms. (T. 98.) 

The following acts well : 

Acid. Salicylic, gr. i. 

Tr. Benzoin., gtts. ii. 

Ung. Aq. Rosse, £i. (Bac.) 

Hydrarg. Oxid. Flav. or Resorcin: — 2—5 per cent, 
ointments in sluggish cases. (T. 98.) 

Acetum Cantharides applied with caution is some- 
times effective. (Bac.) 
The following has been suggested by Van Harlin- 



ECZEMA. 203 

gen for the patient to use during the intervals of 
treatment by the surgeon : 



Acid. Carbolici (crys. ), 




Zinc. Sulphat., 


aa grs. xii 


Glycerini, 


3iii. 


Aq. Rosse, 


ad ^xii. 


Syringe the ear once or twice a day. 





Eczema of the Beard. 

In the acute pustular variety soothing applications 
are indicated. Carbolized Oil, Lime "Water or Di- 
luted Black Wash may be used for bathing the 
affected parts, after which Cold Cream or Vaseline 
may be applied. The hairs should be closely clipped, 
and as soon as the acute stage has passed, daily 
shaving should be required, or shaving at least every 
other day. 

Ung. Vaselini Plumbici- — Spread on muslin should 
be applied after shaving. 

Epilation of hairs situated in the pustules should 
be practiced when the disease has become chronic, 
followed by ointments. 

The following is for use in the squamous form : 



Hydrarg. Ammoniat 


• > 


grs. xx. 




Lanolini, 




Si. 


(Ja.) 


chronic varieties 


(Rosenthal's 


paste) : 




Acid. Tannici, 




3*. 




Sulphur. Prsecipit., 




3". 




Zinc. Oxidi, 








Amyli, 




aa grs. cl. 




Vaselini, 




grs. clx. 


(B.H.) 



Eczema of the Breast and Nipple. 
Wash the nipple carefully, using as little water as 



204 DIGEST OF EXTERNAL THERAPEUTICS. 

possible, dry with a soft handkerchief and dress with 
Zinc or Diachylon Ointment. It is obvious that this 
must be removed before nursing. (Ja.) 

Rubber nipples are useful to wear while nursing 
when there are cracks in the nipple. After drying, 
painting with Tr. Benzoin Comp. or Tr. Myrrh is 
often effective. (B. H.) 

Lister's ointment for fissures : 

Acid. Borici, 

Cerae Albae, aa grs. xv. 

Paraffini, 

Ol. Amygdalae, aa 3ss. 

Wash the nipple with borax i to 25 and apply on muslin. 

Borax: — Useful as an ointment as well as for 
cleansing. 

Thymol with Powdered Zinc Oleate, a drachm to 
the ounce, for eczema under the breasts. (Ja.) 

Nitrate of Silver: — In solution of grs. xvi-^i or the 
crayon for touching the cracks. (B. H.) 

No poisonous application should be used. 

Eczema of the Bars. 

When the disease is situated on the outer part of 
the ear, the same general line of treatment mentioned 
for the disease in other localities is for the most part 
applicable. In applying the dressing care should be 
observed to cover every part and furrow. A pledget 
of lint should be placed behind the ear, so that it will 
be constantly kept separated from the side of the 
head while sleeping. Lotio Nigra may be used first. 
Compressed Oxide of Zinc Lotion also of service. 
These remedies are specially indicated in the vesicu- 
lar form. 

Zinc Oxidef Ointment: — According to Bacon, is 
usually all that is required. 



ECZEMA. 205 

Diachylon Ointment: — Suitable to some cases. 
(Bac.) 

Ung. Vaselini Plumbici.: — Containing 1 per cent, 
of carbolic acid, if there is much itching in subacute 
and chronic conditions. (B. H.) 

Salicylic Acid: — A 5 per cent, solution when there 
is much infiltration will quickly reduce it. (B. H.) 

Sapo Viridis: — When there is a deep crack of long 
standing behind the ears, may be rubbed in briskly 
and followed by tar or calomel ointment si— ^i, or by 
equal parts of pix liquida and ung. zinc oxide. (Yn.) 

Nitrate of Silver — Grs. v— x— §i painted on in the 
moist forms. (T. 98.) 

The ear may be covered during the day with a linen 
bag made like a little ear muff. 

Eczema of the Eyelids. 

Weaker applications are to be employed than are 
used on other parts. Glycerite of Starch, Diachylon 
Ointment, Oxide of Zinc, or Acetate of Lead cerates, 
or dusting powders of Starch alone or mixed with 
powdered Oxide of Zinc in the proportion of 1 of 
the latter to 3 or 4 of the former, should be used in 
the acute varieties. (N. 0.) 

Nitrate of Mercury:— The officinal ointment diluted 
with 3-6 parts of cold cream, or the Red Oxide 
of Mercury, 10 grains, to cold cream 1 ounce, form 
very useful applications for mild cases. (Vn.) 

Aristol: — Has been highly praised. (N. 0.) An oint_ 
ment of 5 grains to 1 drachm of cosmoline has been 
found effective. 

The f ollowing is said to be excellent : 

Acid. Salicylici, grs. x. 

Ung. Hydrarg. Oxid. Rubr., £{. 

Ung. Aq. Rosae, 3 y i- (J a -) 



206 DIGEST OF EXTERNAL THERAPEUTICS. 

Hydrarg. Oxid. Flav.: — Grs. ss-iv, vaseline si, some- 
times known as Pagenstecher's ointment; it may 
be worked in over the eyelids. (Al.) 

For severe cases the eyelashes should be extracted, 
the edges of the lids carefully dried and touched with 
a camel's hair brush moistened with a solution of 
Caustic Potassa grs. x— §i. This application should 
be wiped away immediately and cold water applied. 
Applications may be made daily until infiltration, ex- 
udation and itching are relieved, when a stimulating 
ointment such as the Yellow Oxide of Mercury as 
above may be used. (Vn.) 

Eczema of the Face. 

Crusts when present should be removed by soaking 
in Olive Oil or the Ung. Vaselini Plumbicum, applied 
with strips of muslin. (Hd.) 

Black Wash and Lime Water are of decided bene- 
fit. (Vn.) 

Soothing applications should be employed such as 
the following, which are indicated in the erythema- 
tous variety : 



Zinc. Oxidi, 


Sss. 


Pulv. Calaminse Praeparat., 


9iv. 


Glycerini, 


5i- 


Aq. Calcis, 


Svii 


Zinc. Oxidi, 


Sss. 


Mucilag. Acaciae, 


5i. 


Emulsion Amygdalae, 


5». 


Aq. Rosae, 


ad. giv. 



Or, 



(Hd.) 

The following ointment is described as of great 
general utility: 



ECZEMA. 207 

Zinc. Oxidi, 5*- 

Pulv. Amyli, 3 n - 

Ung. Picis Liq., 3i~ii- 

Ung. Vaselini Plumbici, q. s. ad. gi. 

Spread on muslin and retain in position with a linen mask. 

(B. H.) 

Squires' Glycerole: — This preparation is as fol- 
lows: 

Glycerol. Plumbi Subacetat. , 5 SS - 

Ung. Aq. Rosse, %i. 

Cerat Albse, q. s. (Hd.) 

The following called Provan's Paste is for protect- 
ing the parts when the patient desires to remove the 
applications and go out: 

Tragacanthae, 

Glycerini, aa gss. 

Sod. Biborat., 5 SS - 

Aq. Destill., q. s. (Hd.) 

This forms a thin varnish which protects the skin 
from the air and which can be easily washed off. 

Zinc Oleate: — As a dusting powder for protection 
after the use of pastes. (Hd.) 

Acetanilid:— With cold cream, Bii-iii-^i. (T. 98.) 

Carbolic Acid: — Especially useful for the itching; 
may be used when the disease is at its height : 

Acid. Carbolici, 3^- 

Glycerini, §i. 

Eotio. Nigrse, Oi. (VrO 

Diachylon salve on mull useful for chronic eczema 
of the forehead. (Hd.) 

Lriq. Carbonis Detergens: — 1 part to 8 of water or 
stronger is excellent. (Vn.) 

When ointments agree well the following will be 
found satisfactory : 

Picis Liquidae, 3 ss ~3i- 

Ung. Aq. Rosse, gi. (Vn.) 



208 DIGEST OF EXTERNAL THERAPEUTICS. 

Salicylic Acid Plaster:— 5 per cent, in chronic cases 
is of great value. (Hd.) 
For the healing of cracks and fissures : 

01. Cadini, 5i 

Liq. Guttse Perchae, 

Seu Collodii, §i. 

Eczema of the Genitals. 

The parts should be kept separated by layers of 
linen, and in the case of males the genitalia should be 
wrapped in fine soft linens. In acute cases soothing 
remedies should be employed, such as Zinc and Cala- 
mine, Lead Water, Black Wash, and Lotions of 
Grindelia. 

Medicated Baths: — In acute and superficial forms 
these will give relief. A bath may be prepared as fol- 
lows: Potass, carb., ,^iv.; sod. bicarb., ^ii.; pulv. bor- 
acis., gii. Mix, dissolve in a quart of water and add 
4—6 ounces of dry starch ; this is to be well stirred 
through the water, then 6—8 ounces of glycerine 
added, and the whole mixed with 30 gallons of warm 
water. The patient is to remain in the bath 15 to 20 
minutes ; on removal dry thoroughly and dust on 
Bismuth Subnitrate, or apply some bland ointment. 
(Vn.) 

When the disease is chronic, and there is much infil- 
tration with scaling, more stimulating treatment is 
required, such as the following : Green Soap with 
friction, or Salicylic Acid in Alcohol 3— ^iv, after- 
ward applying Ung. Vaselini Plumbicum, or Salicy- 
lic Acid Plaster 5 per cent, strapped on, Vleminckx's 
Solution, pure or diluted, Wilkinson's Ointment, or 
painting with Caustic Potash, grs. xx-gi. (B. H.) 





ECZEMA. 




or the itching : 






Acid. Carbolici, 




giii 


Glycerini, 




5i- 


Aq. Destil-1., 




Oi. 



209 



This is particularly useful in females, and is best 
preceded by applications of hot water. 

Nitrate of Silver: — A solution in nitrous spirits of 
ether painted on is useful for itching of the scrotum . 
(Yn.) 

Lead Liniment forms a good application. (F.) 

For eczema of trie vulva the following is com- 
mended: Bran Water with Boric Acid during at- 
tack ; in the intervals Salicylic Acid Paste, or Car- 
bolic Acid Lotion 1 part, Balsam Peru 4 parts, oil 
of Sweet Almonds 400 parts ; dusting powder freely 
used. Sitz Baths morning and evening. (T. 97.) 

Eczema of the Hands and Feet. 

Calamine and Zinc Lotion alone, or with Carbolic 
Acid, 5-10 drops to each ounce of lotion, affords re- 
lief to the acute vesicular variety. (B. H.) 

Zinc and Tar: — Useful after the disappearance of 
the more acute symptoms, which leave the parts red 
and somewhat scaly, viz : 

Ung. Picis Iyiq., 
Zinc. Oxidi, 
Ung. Aq. Rosse, 

In subacute and popular eczema : 

Bismuth. Subnit., 
Zinc. Oxidi, 
Pulv. Amyli, 
Acid. Carbolici, 
Vaselini, 

15 



3*- 








Si- 








3vl 








3iv. 








3*. 








3*i. 








M x- 


■XV. 






5i 


(B. 


H. 


) 



210 DIGEST OF EXTERNAL THERAPEUTICS. 

Or, 



Litharge, 


10 parts. 


Glycerine, 


30 parts. 


Starch, 


10 parts. 


Vinegar, 


60 parts. 


To be reduced by boiling to 80 parts. 


(T 



98.) 

Green Soap: — In chronic cases, when there is horny 
thickening of the palms, more vigorous treatment is 
required. Green soap spread on cloths covered with 
a rubber bandage may be applied and retained night 
and day until the epidermis is softened and reduced 
in thickness, then stimulating ointments of tar and 
sulphur should be used. (Yn.) 

Caustic Potash: — Same indications as for green 
soap. 20-40 per cent, solutions applied by the phy- 
sician himself; the hands should be first soaked in 
water as hot as can be touched, then a mop dipped 
into the solution should be rubbed on the parts. If 
the burning is considerable, wash with cold water 
and apply the following : 

Hydrarg. Ammoniat., T)i. 

Adipis, 3 ss. 

Sevi Benzoat., gii. 

Ol. Amygdalae Dulcis, Mx. 

Ung. Petrolei, £vi. 

The above is to be applied on cloths and covered 
with wax paper. This treatment may be employed 
daily until the cracks and fissures heal and the skin 
assumes a healthy appearance. Then the potassa is 
discontinued and weak tar ointment applied, si— ^i. 
(Vn.) 

Salicylated Plasters: — For softening the horny 
epidermis have a very good effect; they are moulded 
to the skin and allowed to remain on for from twenty- 



ECZEMA. 211 

four hours to several days, when they become loose. 
The horny epidermis is scraped away and ointments 
applied. (Kap.) 

Gelanthum: — For dry eczema with marked thicken- 
ing, as a vehicle for Salicylic Acid, Ichthyol, Resor- 
cin, Chrysarobin, or Tar to replace ointments. It is 
more agreeable. (F.) (See Acute Eczema.) 

Thymol and Zinc Oleate: — These remedies, mixed in 
the proportion of 1 part of the former to 8 of the 
latter, form a powder which is more useful than 
ointments when the disease is situated between the 
toes. (B. H.) 

Eczema of the Legs. 

All forms of the disease may occur in this locality 
and should receive the treatment as suggested under 
the general head of this subject ; the following de- 
tails, however, are deserving of special attention : 

Green Soap: — Applied with friction, this remedy 
gives satisfactory results in eczema rubrum ; after 
rubbing on briskly wash off the soap with warm 
water, dry gently and apply Ung. Vaselini Plumbi- 
cum on strips of muslin placed on evenly and care- 
fully retained by a rubber bandage. (B. H.) 

Diachylon Ointment is excellent in moist forms. 
(Vn.) 

The following paste recommended by Unna is said 
by Van Harlingen to give satisfactory results : 

Kaolin, 

01. Lini, aa gvi. 

Zinc. Oxidi, 

Iviq. Plumbi Subacetat. , aa 3 ss. 

To be painted on and allowed to dry; then bandage, changing 
every twenty-four hours. ( Vn. ) 

Ichthyol: — 2 per cent, solution in Glycerine, Al- 



212 DIGEST OF EXTERNAL THERAPEUTICS. 

mond Oil, or Rose Water applied on lint and covered 
with layers of cotton, followed by a 2 per cent. Zinc 
or Diachylon Ointment. (Vn.) 

Glycerole of Lead Subacetate: — Dilutions of vari- 
ous strengths are employed. It is indicated in exten- 
sive chronic eczema rubrum of a dusky hue accom- 
panied by weeping, varicose veins and oedema of 
the subcutaneous tissues. It is also used for palmar 
eczema. (N.) Solutions of 15—30 grains to 1 ounce 
are recommended; saturated strips of muslin are 
carefully applied, covered with waxed paper and 
bandaged. 

Rubber Bandages: — When the veins are varicose 
apply a rubber bandage directly to the skin, remove 
at night, cleanse and disinfect, then dust the leg with 
Starch or Boric Acid. The bandage should be used 
with caution lest it cut the sufrace or macerate the 
tissue. (Vn.) 

Salicylated Soap Plasters: — Most useful in scaly 
conditions ; serviceable in eczema rubrum. (B. H.) 

The following is recommended for general use in 
chronic forms: Ung. zinci oxidi, ung. hydrarg., ung. 
plumbi subacetat., equal parts. (T. 96.) 

Massage is often of service in very chronic condi- 
tions. Before employing, wash the limb with some 
parasiticide soap and follow 7 with a lotion of 
Bichloride of Mercury, 1—1000, or a saturated solu- 
tion of Boric Acid. (Vn.) 

Eczema of the Lips. 

Cold Cream, Lanoline, Zinc Almond Emulsion, 
Ung. Vaselini Plumbicum for acute types. Thymol, 
5 grains, with Cold Cream, 1 ounce, Salicylic Acid 
Plaster, 5 percent., in chronic forms. Tr. Benzoin 



ECZEMA. 213 

Comp. or Collodion painted on serve well, give re- 
lief and protection. (B. H.) 

Dilute Phosphoric Acid: — May be employed as 
follows : 

Acid. Phosphoric. Dil., 
Glycerini, 

Syrupi, aa §ss. 

Apply three times a da}*. ( Vn. ) 

Nitrate of Silver: — The crayon may be touched to 
deep cracks. Afterwards apply Benzoin. 

Hydrarg. Oxid. Ruhr.: — A minute quantity of a 
strong ointment, 40—60 grains to the drachm, for 
very chronic fissures in the lips ; the fissure is torn 
open and the ointment applied with a little stick. 
(Vn.) 

Nasal Catarrh, which is a frequent cause, should 
receive treatment. 

Eczema of the Nails. 

Salicylated Collodion: — Painted on the infiltration 
around the nail, followed by Ung. Vaselini Plumbi- 
cum. (B. H.) 

Tar Ointment: — si-gi gives best results. (Vn.) 

Ung. Diachylon: — Useful when there is much ten- 
derness. (Vn.) 

Salicylic Acid: — The salicylated rubber plaster 
during the day, and an ointment of the acid with tar 
ointment, ^i— %i, when the parts are tender. (Vn.) 

Eczema of the Nares. 

This affection is often associated with chronic 
rhinitis ; when such is the case the first effort should 
be directed to the treatment of the latter condition. 
All crusts should be removed by soaking in Olive Oil, 



214 DIGEST OF EXTERNAL THERAPEUTICS. 

which can be dropped into the nose or applied with 
a camel's hair brush ; when thoroughly softened they 
can be easily removed, after which one of the follow- 
ing may be used with good effect: Ung. Hydrarg. 
Oxidi Flav.; Ung. Plumbi and Vaseline, equal parts; 
Glycerole of Lead Subacetate and Ung. Aq. Rosae, 
equal parts . ( Hd . ) 

Zinc and Red Precipitate Mull:— Small rolls of pa- 
per covered with the mull and inserted up the nostril 
are recommended by Unna. 

Eczema of the Scalp. 

In children and men the hair should be cut short, 
but this is not necessary in women. If crusts are 
present the}' may be removed by Olive Oil ; saturate 
the scalp, cover the head with a cap and wash off in 
the morning; repeat if necessary, or use Starch Com- 
presses to scalp, allowing them to remain on for a 
little while, or Starch and Boric Acid, each 1 
drachm, water, 1 pint. (Vn.) 

Sodium Bicarbonate: — Very useful in solution ap- 
plied in the same manner for removing crusts in in- 
fantile variety. The following is recommended : 

Sod. Bicarb., ^i. 

Liq. Sod. Chlorinat., ^i. 

Aq. Destill., gxii, (Al.) 

Liq. Potass.: — 1 part to 8-12 of olive oil for re- 
moval of crusts in children. (Jac.) 

The above applications prepare the scalp for more 
active medicinal agents. 

Lotio Nigra:— Alone or better with Aq. Calcis for 
acute inflammatory conditions. Apply with sponge 
for ten or fifteen minutes and follow with an oint- 
ment. (Vn.) 



ECZEMA. 215 

Ung. Vaselini Plumbicum: — Spread on strips of 
muslin and retained by a cap, useful when the hair is 
short ; and in acute forms in young infants. (B. H.) 

Carbolic Acid: — Solutions are useful. Same indica- 
tions as for black wash. (Vn.) 

The following ointments are recommended by Van 
Harlingen : 

Bismuth. Subnitrat., 
Ung. Petrolii, equal parts. 

Or, 

Hydrarg. Ammoniat., grs. x-xx. 

Ung. Petrolii, £i. 

The latter is more stimulating, and indicated in 
subacute and chronic forms as a substitute for tar 
preparations. 

Jacobi recommends after the removal of crusts : 

Bismuth Subnitrate, 5 parts ; Vaseline, Zinc Oxide 
Ointment, each 20 parts, 

Or Hebra's Diachylon Ointment spread on linen 
and worn for days or weeks. 

Salicylic Acid or Sulphur: — 20-30 grains of either 
to the ounce often has striking effects after subsi- 
dence of acute symptoms, or when the condition from 
the onset has been more of a moist exudation. (B. H.) 

Salicylic Sulphur Ointment: — Nothing, says Hard- 
away, is so useful in the dry, scaly, chronic forms of 
the disease; the following combination being recom- 
mended : 

Acid. Salicylici, 9i. 

Sulphur Praecipit., £i. 

Vaselini, Ji. 

01. Limonis, q. s. 
Rub in scalp thoroughly once or twice daily. 

The following is recommended as the best applica- 



216 DIGEST OF EXTERNAL THERAPEUTICS. 

tion after the more acute symptoms have disap- 
peared : 

Ung. Picis Liq., 3 i— ii . 

Zinc. Oxidi, 31. 

Ung. Aq. Rosse, %i. 

Spread on muslin if there is no hair; otherwise smear on gently 
with the fingers. (B. H. ) 

Nitrate of Silver: — 1—2 per cent, solutions ap- 
plied daily, or at longer intervals, followed by 
salves. (Duh.) 

Resorcin: — 5 per cent, as a salve or lotion with 
glycerine or alcohol is of benefit. (B. H.) 

Balsam Peru:— Useful in children when the healing 
process is slow. (Jac.) 

Tar: — Used when still stronger stimulation is 
necessary, viz : 

Ol. Cadini, ^ss. 

01. Olivse, %i. (B. H.) 

For adults when there is intense pruritis. 
Or, 

Picis Liquid., 3L 

Vaselini, %i. (Vn.) 

Tar and Mercury together often act beneficially, 
viz.: 

Hydrarg. Ammoniat., 9i. 

Liq. Carbonis Deterg., ^ss. 

Lanolini, gi. (B. H.) 

Tannic Acid: — When there is a tendency to greasi- 
ness. 
The following ointment is useful : 

Acid. Tannici, £ss-i. 

Acid. Carbolici, M v x. 

Cerat. Galeni, gi. . (B. H.) 



ECZEMA. 217 

Calomel and White Precipitate: — These remedies 
may be substituted for tar with the same indications , 
when the latter is not well tolerated. They may be 
used alone in the strength of from 20—60 grains to 
the ounce. Calomel ointment has a stimulating and 
drying effect and is useful when there is discharge. 

Glycerine and Alcohol: — May be substituted in the 
various preparations for vaseline when the hair is 
long. All ointments should be soft. 

Universal Eczema. 

The patient should be kept in bed. The most effect- 
ive applications are lotions and oils, viz : Carron 
Oil, Cotton Seed Oil, and Carbolic Acid, 1 part of 
the acid to 60 of the oil, or anoint the body with 
Vaseline and apply Starch Powder, or Salicylic Acid 
in Olive Oil, 1 part to 30. (Ja.) 

Bulkley recommends after drying the skin : 

Carbolic Acid, 9i~3i- 

Glycerite of Starch, %iv. 

Macintosh's cream is an excellent preparation. Its 
composition is as follows : 

Bismuth. Subnitrat., 3ii- 
Zinc. Oxidi, 5 SS - 
Glycerini, 5i ss - 
Acid. Carbolici, M xx-xxx. 
Vaselini, ^vi- 
Apply with a brush. The carbolic acid may be omitted or re- 
duced for universal application. (B. H. ) 

Alkaline Baths, followed by one of the oily appli- 
cations, after gently drying the skin, are effective. 
The bath, temperature of which should be 98°, 
should continue for ten or fifteen minutes. The best 
way to dry the body is to wrap the patient in 



218 DIGEST OF EXTERNAL THERAPEUTICS. 

a warm sheet and pat the skin dry. After replacing 
the patient in bed cover him with dusting powders 
and wrap him in a sheet. (Kp.) 

When the skin is thick and scaly, Wilkinson's Oint- 
ment 10 per cent., pigments of Salicylic Acid or 
Chrysarobin in Traumaticine, Sulphate of Zinc gii- 
iv-Oj, and the following solution of Lead and Tar: 

Liq. Carbon. Deterg., ^ii. 

Liq. Plumbi Subacetat., 3 n - 

Aq. Destill., gviii. (B. H.) 

Solutions of Menthol and Carbolic will prove use- 
ful for the relief of the Pruritus. (See that subject.) 



ECZEMA SEBORRHCEICUM. 

The principal treatment is local and most cases, 
even those of long standing, will be found amenable 
to mild measures. 

Sulphur: — One of the best remedies for the moist 
variety. (Ja.) 

Among its combinations the following will prove 
useful: 



Sulphur, praecipitat. , 




3ss-i. 


Zinc. Oxidi, 




grs. xv 1. 


Lanolini, 






01. Amygdalae, 




aa. giii. 


Ext. Violet, 


q 


, s. M. (Br 



Resorcin: — One of the most effective remedies in so- 
lution and ointments. (F.) For the hairy parts a 
solution in alcohol and water is as follows : 

Resorcin., 3 ss- i- 

Spts. Vini Rect., 

Aq. Destill., aa giss. 



ECZEMA SEBORRHCEICUM. 219 

Or, 

Resorcin., 9iv~3iii. 

01. Ricini Pur., 3i ss - 

On non-hairy parts 10-30 grains to 1 ounce of ointment base, 
applied daily, acts well. (B. H. ) 

For irritable forms in the folds of the skin, and for 
the moist variety, the following may be used with 
good effect: 

Resorcin., grs. xii. 

Zinc. Oxidi, 3 SS 3*- 

• Cerat. Simp., 3v. (Vn. ) 

For the disease in children the following is espe- 
cially recommended : After removal of crusts apply 
compresses soaked in resorcin, 6-1000. At night ap- 
ply an ointment of 1 part of Balsam of Peru and 
1-30 of vaseline. (T. 96.) 

Sulphur and Resorcin may be combined with ad- 
vantage. A 3—6 or 10 per cent, salve of the former 
with 1—3 per cent, of resorcin may be employed. 

The following constitutes a useful formula: 

Resorcin., grs. v-xv. 

Sulphur Praecipit., grs. xv 3 SS - 

Ung. Aquae Rosae, %i. (B. H.) 

Boracic Acid, or Salicylic Acid, may sometimes be 
substituted for resorcin, the former in 3—5 per cent, 
strength and the latter in 1—2 per cent. 

The following is often used : 

Hydrarg. Chlorid. Mitis, grs. viii-xv. 

Zinc. Oxidi, 3 ss ~i- 

Petrolati 3 v. (Vn.) 

Chrysarobin, Anthrarobin and Pyrogallic Acid in 
the strength of 2-10 per cent, ointments or lotions 
may be used in those cases marked by scaliness and 



220 DIGEST OF EXTERNAL THERAPEUTICS. 

incrustation (Ja.), and in those resembling psoriasis. 
(B.H.) 

Ol. Cadini and Ichthyol ointments are beneficial. 

Ichthyol Soap should be used for general cleansing,, 
and Sublimate Soap for the scalp. 



EMPHYSEMA. 

Systematic long-continued practice in Expiratory 
Exercises are recommended. (T. 97.) 

Condensed Air Baths:— Often afford marked re- 
lief, but are contra-indicated when there are cardiac 
lesions and the age of the patient is over 50. (F.) 

Ozone Inhalations: — Have been used, it is said, with 
apparently good effect. (F.) 

Oxygen Inhalations: — Sometimes prove useful. 
(Gn.) 

Treatment of Waldenburg: — This consists of in- 
spiring compressed air and expiring into rarified air. 
It is recommended as deserving further trial. (An.) 

Forcible Compression of the Chest: — This must 
usually be exercised by an attendant. An apparatus 
is described by Strumpell for this purpose. It con- 
sists of two boards fastened behind and allowed to 
project in front, so that the patient, taking hold of 
the projecting ends, can compress his own chest with 
each expiration. Compression should be coincident 
with each expiratory movement. (Ty.) 



EMPYEMA. 

Local treatment is surgical. Pus must be removed 
by aspiration or incision. 



EMPYEMA. 221 

Aspiration: — Adequate for the majority of cases. 
(L. T.) It may be employed when septic symp- 
toms are not urgent. • (W.) Anaesthesia is con- 
demned as dangerous (Sj.), but local anaesthesia in 
the form of rhigoline or injections of cocaine may be 
advantageously employed. It is advisable to make 
an exploratory puncture before operating. 

Incision and Free Drainage: — The incision should 
be from two to three inches long, and a large sized 
drainage tube inserted with the end secured with a 
safety pin. It should be made in the eighth intercos- 
tal space a little back of the axillary line ; the skin 
and muscles are gradually divided down to the 
pleura, which is then incised . Strict antisepsis should 
be observed in all details, and the patient should be 
anaesthetized. (Ger.j 

Exsection of the Rib: — Recommended for free 
drainage, removing about one to two inches of the 
rib. It is superior to simple incision on account of 
the free exit which it affords, allowing the large 
masses of fibrinous pus to escape. (L. T.) It has 
also been recommended for children, on account of 
the smallness of the space between the ribs, which 
produces compression of the drainage tube. (T. 96.) 

Irrigation: — Formerly thought to be of primary 
importance and absolutely essential. Many recent 
writers, however, are beginning to regard it in a 
somewhat different light. All agree that it is imper- 
ative when the pus is offensive. (L. T.) 

Salicylic Acid 3 per cent, or Boric Acid saturated 
solution in sterilized water, recommended for irriga- 
tion of the cavity after removal of pus. (L. T.) 

Hydrogen Peroxide: — Diluted one-half, especially 
recommended for washing out the cavity. (Gn.) 



222 DIGEST OF EXTERNAL THERAPEUTICS. 

Pyoktanin Blue:— In solution 1-1000 to 2000, is 
well adapted for irrigation, being non-poisonous. 
(Al.) 

Hydrarg. Bichlorid.: — 1-5000 for irrigation, fol- 
lowed by a final flushing of the cavity of 1—1000 ; 
great care should be observed to drain off all residue 
of this solution by turning the patient on the side. 
(Ger.) 

This agent is recommended by many surgeons. 

Tr. Iodine: — The undiluted tincture, Bartholow 
says, is thrown into the cavity without risk and with 
great benefit. 

The Liq. Iodi Comp. in the proportion of 1 part 
to 15 of distilled water may be used for washing out 
the same. (B.) 

Sty rone: — For washing cavity after exsection of 
the rib, solutions of 1—200 may be used, gradually 
increasing to 1—40. (Al.) 

Iodoform Gauze Packing: — The careful introduc- 
tion, into the incision, of a roll of iodoform gauze is 
preferred by Anders to irrigation, except when the 
pus is offensive. A pad of oakum covered with the 
gauze forms an excellent dressing for old cases. 
(L. T.) 

Syphon of Revilloid: — This method is recommended 
for intractable cases which are incurable by the so- 
called classical methods. Favorable results have 
been reported in cases of this unpromising nature. It 
is described as follows: The syphon consists of a tube 
of black rubber which is inserted into the pleural cav- 
ity ; two feet from the proximal end is placed a bulb; 
the tube is continued for three or four feet, and its 
end is placed in a receptacle containing an antiseptic 
solution — either carbolic acid or creolin — so as to 



ENCEPHALITIS, MENINGITIS, ETC. 223 

prevent the entrance of air. The proximal end is re- 
tained in position with plaster. If there is no fistula, 
an incision is made near the posterior axillary line. 
After making the incision, which should be large 
enough to allow the free escape of pus and mem- 
brane, the syphon is introduced, and the lips of the 
incision hermetically sealed around the tube. All 
that is necessary now is careful watchfulness on the 
part of the surgeon. (B. M. S. J., 11, 22, 94.) 

Estlanders Operation: — May be considered in old 
and inveterate cases with or without sinuses. (Ger.) 

James' Method for Expansion of the Lungs: — This 
has been practiced with success. The patient for a 
certain time transfers water by air pressure from one 
bottle to another. The bottles should hold about a 
gallon each, and by an arrangement of tubes the pa- 
tient forces the water from one bottle to another. 
The strength or quantity of the transfer is increased 
as the patient's strength progresses. Thus the ex- 
pansion of the lung is systematically practiced. (An.) 



ENCEPHALITIS, MENINGITIS, AND 
CEREBRAL CONGESTION. 

Ice Bags and Cold Compresses should be applied 
to the head, and the patient kept in bed with as 
little physical restraint as possible. (Gn.) 

In cerebral congestion with much mental excite- 
ment, great and speedy relief may frequently be ob- 
tained by packing the legs from the groin to the feet 
inclusive in large towels which have been wrung out 
in hot mustard water. The towels should be covered 
with blankets, and after the pack the limbs should 
be quickly rubbed with tepid damp towels. (Rd.) 



224 DIGEST OF EXTERNAL THERAPEUTICS. 



ENDOCARDITIS. 

ACUTE ENDOCARDITIS: 

An Ice Bag to the chest over the region of the 
heart affords marked amelioration of symptoms in 
endocarditis from acute infectious diseases, the pain 
and palpitation are relieved and the temperature 
lowered. A layer of flannel should be placed between 
the bag and the skin, otherwise erythema may ap- 
pear. (T. 98.) 

Hot Fomentations, as mustard or linseed poultices, 
for relief of pain are preferred in some cases. (Bt.) 

Blisters are used by some in acute rheumatic types. 
(T. 97.) 

CHRONIC ENDOCARDITIS: 

(See Valvular Disease of the Heart.) 



ENDOCERVICITIS, AND CERVICITIS. 

ACUTE ENDOCERVICITIS AND CERVICITIS: 

From a clinical standpoint these conditions do not 
need to be considered separately from Acute Endo- 
metritis and Metritis. (K. C.) 



CHRONIC ENDOCERVICITIS, AND CERVICITIS 
AND EROSION. 

Remove the plug of mucus from the cervix with 



ENDOCERVICITIS, CERVICITIS, ETC. 225 

cotton on an applicator, and thoroughly cleanse be- 
fore using local remedial agents. 

Tepid Water Douches: — For cleanliness unless the 
hot water douche is used. 

Hot Water Douche: — Large quantities of very hot 
water are generally employed, with good effect, but 
at the same time frequently abused. (Sw.) 

Iodine: — One of the most efficacious remedies, indi- 
cated in granular degenerations and in all chronic 
conditions ; contra-indicated in acute inflammations. 
Apply with a brush, inserting it well up in the canal. 
Churchill's iodine should be used. (Sw.) 

The following is recommended when there is uterine 
colic : 

Tr. Iodine and Creosote each 5i- 

Glycerine, §i. 

To be applied on tampons. (Ch.) 

Glycerine: — The chief agent is local applications 
for relief of congestion ; used largely as a vehicle for 
other remedies, as well as for its local depleting 
effects. 

Ichthyol: — Regarded by many as one of the most 
efficient remedies ; is of great benefit and wide range 
of application. It is used in various strengths from 
5-50 per cent, in glycerine, sometimes pure. (F.) 

Iodotannin: — Packed around cervix is of undoubted 
value (B.); alterative and astringent. 

Carbolic Acid: — As a disinfectant, in 2—5 percent, 
solutions for douches; also as a mild caustic and 
a stimulant for erosions. (Sw.) 

Boroglyceride: — One of the most valuable applica- 
tions in erosions with effusive leucorrhcea and itching 
of the parts. Used diluted with twice its bulk in gly- 
cerine or in the form of a cerate. 
16 



'226 DIGEST OF EXTERNAL THERAPEUTICS. 

Calendula: — When erosions are very red and bleed 
easily, this remedy may be used with good effect in 
varying strengths ; 2 drachms to 8 ounces of tepid 
water will form a useful douche. Non-alcoholic 
preparations are preferable. (M. H.) 

Hydrastis: — Useful in powder, tincture or cerate in 
cases attended with profuse stringy leucorrhcea. 
Equal parts of the extract and boroglycerine very 
useful. (Bt.) 

Hamamelis: — May be used when soothing effects 
are indicated ; as in erosions that are sore and bleed- 
ing ; or in venous engorgement and piles ; the cerate 
or watery extract with equal parts of glycerine, as 
an application or injection. Iodoform added is a 
useful adjuvant. (Bt.) 

Iodoform: — A very effective remedy. Its odor may 
be somewhat counteracted by chloral hydrate, the 
tampon being soaked in the following : 

Iodoform, 3*- 

Chloral Hydrate, grs. xx. 

Glycerine, %i. (Sw. ) 

Sanguinaria: — Equal parts with myrrh and hy- 
drastis mixed so as to form a fine powder, applied in 
the usual way with wool tampons, form a most ex- 
cellent and effective remedy. (Sw.) 

Tannin: — For astringent effect when relaxation of 
the parts is prominent, applied on glycerine tampons. 
(M.H.) 

Chromic Acid: — A 50 per cent, aqueous solution in 
obstinate cases with glairy mucus discharge, espe- 
cially when a laceration exists. Application should 
be made only once a week and only in exceptional 
cases. (Sw.) 

Zinc Oleate: — 1 part with iodoform 2 parts. (F.) 



ENDOCERVICITIS, CERVICITIS, ETC. 227 

As an astringent when parts are excoriated and there 
is a fetid leucorrhoea. 

Thymol: — 1 part to 1000 or 3000 on glycerine 
tampons. (F.) 

Zinc Sozoiodate: — The powder gives satisfactory 
results. (Al.) 

Aristol: — When the consent of the patient cannot 
be obtained for the repair of a lacerated cervix, a 
pencil of five grains of aristol made up with gum 
arabic may be introduced daily and retained b} r a 
tampon. It should remain in for twenty -four hours; 
then the cervical canal should be syringed out with 
the following solution, using two tablespoonfuls to 
a quart of water : 

Salicylic Acid, 4 parts. 

Spts. Lavender, 30 parts. 

^ Water, 450 parts. (T. 98.) 

The aforementioned remedies are nearly all to be 
applied on glycerine tampons. (For the use of injec- 
tions, see Leucorrhoea.) 

Curettage: — When other means have failed, and the 
cervix remains thickened and enlarged, the entire sur- 
face from the internal to the external os should be 
scraped with the curette. (K. C.) (For details of 
procedure see works on Gynaecology.) 

Shrceder's Operation: — This is indicated when the 
disease has penetrated deeply, where superficial appli- 
cations will always fail. Deep acting caustics may 
have curative effect but they produce cicatricial con- 
traction. Thorough excision and covering the ex- 
posed surface by a plastic operation, as recommended 
by Shrceder, will give the best results. (Dud.) 

Steam Evaporization for the treatment of endocer- 
vicitis has recently been employed. (See Endometri- 
tis.) 



228 DIGEST OF EXTERNAL THERAPEUTICS. 



ENDOMETRITIS AND METRITIS. 

ACUTE ENDOMETRITIS AND METRITIS: 

Mild Forms. 

Rest in bed and Hot Vaginal Douches, temp. 115°.; 
four quarts of water should be used every three or 
four hours. (K. C.) 

Hot Fomentations over hypogastrium will gener- 
ally control pain and render opiates unnecessarv. 
(Cp.) 

Scarification of the Cervix: — May be employed 
with good effect to induce rapid depletion ; after an 
interval of four or five hours, use hot douches fol- 
lowed by glycerine tampons. (K. C.) 

More Severe Forms. 

Gonorrhoeal: — Dilate the cervix under anaesthesia so 
as to admit a small sized uterine speculum, then copi- 
ously irrigate with Bichloride of Mercury, 1-3000 ; 
use a quart, then pack the cavity with sterilized 
gauze, one end of which should be allowed to re- 
main in the vagina to permit of easy removal. The 
vaginitis, which is present, should receive treatment. 
At the end of twenty-four hours this procedure should 
be repeated. The os will remain open sufficiently to 
dispense with dilatation again. Creolin will facili- 
tate the introduction of the gauze. (K. C.) 

Ice to theAbdomen and theWet Pack. (T. 96.) 
Cauterization: — May be tried if appendages are in 
good condition, in order to destroy the gonococci, 
using Phenol Alcohol, 50 per cent. Chloride of Zinc, 



ENDOMETRITIS AND METRITIS. 229 

20 per cent., Tr. Iodine, 20 percent., or Nitrate of 
Silver, 10 per cent. (T. 96.) 

Septic Inflammation Following Operations: — When 
in the non-pregnant uterus prompt measures are nec- 
essary ; the cut surfaces of the cervix should be ex- 
posed and freely cauterized with pure Carbolic Acid, 
and the uterine cavity irrigated with a Bichloride of 
Mercury Solution 1-3000, and then packed with 
Sterilized Gauze. Curetting is rarely required in this 
condition. The wounded surfaces should be kept 
apart hy sterilized gauze which should be retained by 
packing the vagina with the same. If the symptoms 
improve, remove the vaginal packing at the end of 
two days, leaving that of the uterus in place for four 
or five days. It should then be withdrawn and the 
cavity not entered again. Vaginal douches should 
be employed after the removal of the vaginal pack- 
ing and continued until the removal of the uterine 
packing; then apply glycerine tampons. The cut sur- 
faces should then receive attention, being treated by 
cauterants, astringents, or a new operation per- 
formed as deemed best. If unfavorable symptoms 
continue, emplo}^ the treatment mentioned for the 
graver forms. (K. C.) 

Grave Forms of Inflammation — Puerperal. 

Curettage: — The cavity of the uterus should receive 
prompt and energetic treatment without delay. 

Cleanse the vulva, vagina, cervix and cervical canal 
with a copious supply of water and green soap, using 
the finger and a wad of cotton in a pair of long 
handled forceps. Dilate the internal os if necessary ; 
then irrigate the cavity of the uterus freely with 
bichloride of mercury, 1-2000. After the irrigation 
curettage should be done, examining with the fingers 



230 DIGEST OF EXTERNAL THERAPEUTICS. 

from time to time to make sure that all detritus has 
been removed. The sharp curette, double curette for- 
ceps, or placental forceps are recommended. After 
curetting, irrigate with the same solution at a tem- 
perature of 115°-120°. Even if there is excessive 
haemorrhage, little time should be given during curet- 
ting to checking the bleeding, which is most always 
copious, as the hot irrigation so soon to be applied 
will arrest it. After this procedure pack the uterine 
cavity with folds of sterilized gauze through the 
uterine speculum. At the end of twenty -four hours 
remove the packing, and if there is no fever the cavity 
of the uterus may be left, but if the temperature is 
still elevated remove the packing, irrigate and apply 
fresh. This should be repeated at intervals as indi- 
cated. This treatment b}^ curettage and drainage 
should be persistently pursued in even the most des- 
perate cases. (K. C.) 

Alcohol Gauze: — Gauze soaked in alcohol and used 
for packing is recommended by Grandin, who says 
iodoform gauze is liable occasionally to produce poi- 
soning. (E.J.) 

Hydrogen Peroxide : — Commended for flushing out 
cavity of uterus after curettage. (Al.) 

Lysol, Potass. Permang., and Carbolic Acid, in 
vaginal douches may be repeated every two or three 
hours ; if there is no improvement wash out uterus 
with mild antiseptic solutions, repeating every twelve 
or twenty-four hours. (T. 96.) 

Camphorated Alcohol : — Recommended for cauter- 
izing after curettage for removal of placental frag- 
ments. (T. 96.) 

Continuous Irrigation: — Advocated when the tem- 
perature remains unaffected. Weak Carbolic, Boric 



ENDOMETRITIS AND METRITIS. 231 

Acid, or Lysol solutions are used. Irrigation is main- 
tained continuously for twelve hours or more. Fol- 
lowing this the inner surface of the uterus is painted 
with Tincture of Iodine undiluted. (T. 98.) 

CHRONIC ENDOMETRITIS AND METRITIS: 

Displacements and lacerations should receive im- 
mediate attention. 

Acute and subacute metritis, inflammation of the 
appendages, para- and perimetritis, are contra-indi- 
cations to local interference in the endometrium. 
Cervical or vaginal catarrh if present should also re- 
ceive attention. 

The plug of mucus in the cervical canal must first 
be extracted before anything can be accomplished ; 
this is sometimes difficult with ordinary forceps or 
application with cotton. In that case a small syr- 
inge with a short rubber tubing attached to the 
nozzle may be used. The tubing is inserted into the 
external os, and the mucus removed by suction. A 
narrow piece of sponge on forceps may also be em- 
ployed for this purpose. If the os is contracted it 
must be dilated or incised in order to admit of free 
exit for the pent up secretions. (Sw.) 

The remedies mentioned for chronic endocervicitis 
for application to the external os and cervical canal 
are also indicated in this condition. The reader is, 
therefore, referred to that subject. 

Local Depletion will temporarily relieve, allowing 
about half an ounce of blood to escape by puncture 
or scarification. (Sw.) 

Hot Water Douches and Hot Sitz Baths:— The 
systematic use of the hot douche combined with the 
hot sitz bath is very important. (Sw.) 



232 DIGEST OF EXTERNAL THERAPEUTICS. 

Glycerine Tampons: — Frequently applied tend to 
depletion, and should follow daily the hot water 
douches. (K.C.) 

Electricity: — Great benefit is sometimes afforded by 
a mild galvanic current applied every second or third 
day, negative pole in the uterus, positive over the 
hypogastrium. The current should be from 8- 
12 milliamperes. (Sw.) In the stage of infiltra- 
tion the positive pole of galvanic current and zinc 
electrolysis with faradization ; in the stage of indur- 
ation, dilatation, curettage and gauze packing prove 
more satisfactory according to Goelet. (Sj.) 

Intra-Uterine Applications: — In addition to the 
aforementioned remedial agents, applications directly 
to the surface of the endometrium are employed. 
There seems to be some divergence of opinion as to 
the utility of these measures, especially in regard to 
cauterants, which are condemned by some as more 
harmful than productive of good. On the other hand, 
the most recent writers advocate their employment. 
The remedies which meet with the most general ap- 
probation in utra-uterine treatment are Iodized 
Phenol, Carbolic Acid pure, and Iodine ; the best re- 
sults being obtained after curretage. Before adopt- 
ing this method the os should be dilated with lami- 
naria tents, and no irrigation of the uterine cavity 
should be attempted unless the os is patulous. 
The external parts should be scrubbed with soap and 
water, antiseptic vaginal douches administered, the 
i^agina wiped dry and swabbed with a 5 per cent, so- 
lution of Carbolic Acid, then with a 1 per cent, solu- 
tion of Creolin; slight traction is made on the cervix 
with the blunt hook or tenaculum. After the appli- 



ENDOMETRITIS AND METRITIS. 233 

cation has been made, a tampon of Ichthyol Ammo- 
niate 1—10 in glycerine is advised, and over this a dry 
cotton tampon. (Dud.) 

Carbolic Acid: — The undiluted acid is generally re- 
garded as the safest and most efficient remedy, since 
it does not burn deep enough to destroy the submu- 
cous tissue. (Sj.) According to Bartholow it is the 
best agent for the treatment of uterine catarrh. 

Ichthyol: — Applied pure to the fundus gives relief to 
pain and dragging sensation and lessens leucorrhoea. 
(F.) 

Tr. Iodi Comp. (Churchill's): — This remedy is 
much used and is very generally advised. (Sw.) 

Iron Sesquichloride: — In mild forms with metror- 
rhagia, also in bleeding from myomata, and paren- 
chimatous haemorrhages, injections into the uterine 
cavit\ T without dilatation have been recommended. 
(T.96.) 

Zinc Chloride: — 10 per cent, solutions are used. 
Munde has employed 50 per cent, solutions w r ith 
good results in the w r orst cases. The solution is to 
be thoroughly applied and followed by the in- 
sertion of a sterilized drain through the internal os. 
Treatment by this agent has been abandoned by 
man}^ because of the tendency to cicatrization of the 
surface. (Sj.)* 

Iodized Phenol: — Recommended also by Munde 
for use in milder cases, and for cauterization after the 
use of the strong zinc chloride, when a second cauter- 
ant application is deemed advisable. A sterilized 
drainage tube is to be inserted through the internal 
os as above. 

Nitric Acid: — When the disease fails to respond to 



234 DIGEST OF EXTERNAL THERAPEUTICS. 

ordinary treatment, and the mucous follicles are the 
seat of C3^stic degeneration, or where the granula- 
tions have become very exuberant, this agent is use- 
ful. The cavity of the uterus may be touched with a 
cotton wrapped applicator dipped in the acid ; the 
parts should be thoroughly cleansed first and the cer- 
vix well protected from the acid. It is well to place 
in the vagina beneath the cervix a pledget of cotton 
soaked in a solution of bicarbonate of soda to pro- 
tect the vaginal mucous membrane. After the acid 
has been used, remove the cotton and syringe with 
water, after which a glycerine tampon is applied and 
renewed daily. Nitric acid is condemned by some 
writers, together with other powerful caustics, as de- 
cidedly injurious. It is, however, recommended 
in those cases of the haemorrhagic types which 
develop in connection with the menopause and 
membraneous exudation. A vulcanite intra-uterine 
speculum is recommended to prevent the acid from 
getting on the cervical canal. (Alb.) 

Actual Cautery: — This agent may be employed in 
inveterate cases of the variety mentioned as indicat- 
ing the use of nitric acid. (K. C.) 

Chromic Acid: — Solution of 15 grains to 1 
drachm. (B.) 

Curettage: — For intractable forms, strongly indi- 
cated when there is inflammation of appendages or 
uterus ; anaesthesia and thorough antisepsis are es- 
sential. After thoroughly cleansing and douching 
with antiseptic solutions, dilate the cervix, insert a 
uterine cylindrical speculum, then flush the cavity of 
the uterus with a warm solution of bichloride of mer- 
cur}r, 1-2000, to the amount of one or two pints. 



ENDOMETRITIS AND METRITIS. 235 

After this apply the curette, using a sharp instru- 
ment aided by the double curette or forceps of Em- 
met. After this introduce again the uterine speculum 
and irrigate copiously with the bichloride solution 
same as before. The uterus is then packed with a 
strip of gauze which has been previously placed in a 
bichloride of mercury solution 1-500. This gauze 
should be a strip about four feet in length and folded 
four times. Catch an end upon a Sims tampon screw, 
and pass it into the uterus through the speculum, 
length by length, packing it in carefully, first at one 
cornu then at the other, then at the fundus, grad- 
ually withdrawing the speculum. The vagina is then 
packed with gauze. At the end of forty -eight hours 
the vaginal packing is removed ; the vagina is then 
drenched twice daily until the uterine packing is re- 
moved, which is done on the sixth day. The vigor 
w T ith which the curettage is performed will depend 
upon the conditions present ; hemorrhagic forms call 
for a more energetic application than recent subin- 
volution, or the endometritis of simple stenosis. The 
anterior and posterior walls, the fundus and the sulci 
and the recesses of each cornu are all to be scraped in 
turn. (K. C.) 

The following line of treatment has been suggested 
for endometritis in aged women attended with puru- 
lent vaginal discharge : Swab out the vagina with 
strong Carbolic Acid, or prescribe frequent astring- 
ent injections such as Zinc Chloride 5-10 grains to 
the pint. Repeat the carbolic acid applications two 
or three times, taking care that none goes on the 
vulva. If this is not successful, Dilate the Cervix 
with laminaria tents and explore the interior; if 
growths are discovered examine specimens of the 



236 DIGEST OF EXTERNAL THERAPEUTICS. 

structure microscopically; if there are no growths 
scrape with Blunt Curette and swab the cavity with 
Carbolic Acid or Lin. Iodi. This is said to always 
remove the symptoms for a time. (T. 98.) 

The following are recommended for glandular 
forms : 

Sodium Solutions: — To remove mucous secretions, 
employ sodium solutions injected daily by means of 
a simple catheter, followed by Carbolic Acid 2 1 /£ per 
cent, solution, and finally by Lysol Solution 1 per 
cent. (T. 96.) Another plan of treatment for slight 
glandular endometritis consists of the injection of 
x /4— V2 quart of Sodium Solution, 3 per cent., fol- 
lowed by Carbolic Acid, 2 per cent., Lysol, y 2 per 
cent., Nitrate of Silver, 2 per cent., or Zinc. Chloride 
or Cupric Sulphate or Cupric Aluminate, 5 per cent. 
These injections are made into the uterus through an 
ordinary catheter, the instrument being moved from 
side to side to allow the fluid to flow out. 

The instrument having been removed, a tampon of 
iodoform gauze is placed below the uterus, and the 
patient allowed to rest an hour to avert uterine colic. 
(T. 96.) 

Traumatol: — Pencils are recommended as having 
produced successful results. (F.) 

Vaporization: — Introduction of steam into the 
uterine cavity has been used in hyperplastic endome- 
tritis with severe haemorrhage. (F.) With regard 
to the technique of the procedure, the use of a wooden 
tube for the protection of the cervix is advised. This 
is considered preferable to gauze, which becomes too 
readily saturated with hot vapor. The wooden 
tubes should be kept in a disinfectant solution. If 
there is a tendenc}' of the metal tubing for conducting 



ENURESIS. 237 

the steam to become stopped with clots, it will be 
necessary to carefully empty the uterus of blood ; the 
vapor heated to 110° C. will arrest the haemorrhage 
in a short time. It is desirable to use vapor for the 
shortest possible time ; one-quarter minute is suffi- 
cient for most cases, and one-half minute should be 
considered the maximum. The temperature should 
range between 102° and 110° C. The higher the 
temperature the shorter the time of application. A 
case of abortion with considerable haemorrhage is 
mentioned in which vaporization rapidly arrested the 
bleeding. (C. G., 8, 24, 98.) 

The f ollowing general line of treatment is recom- 
mended in place of more conventional methods : Va- 
ginal douches, astringent injections, vaginal and in- 
tra-uterine applications of dry powders, intra-uterine 
pencils, intra-uterine gauze tamponing. (Dud.) 
Euphorbin: — Intra-uterine pencils are used. (F.) 
The following solutions are recommended by Pozzi 
for injections : 

Hydrarg. Bichlorid., 1-3000. 
Alum, ^ss-Oi. 
Tannic Acid, ^ss-Oi. 
Boric Acid, ^i-Oi. 



ENURESIS. 

The bladder should be emptied before retiring, and 
the patient sleep on a hard mattress with light cloth- 
ing, and avoid lying on the back ; this may be pre- 
vented by fastening an empty cotton spool to a belt 
which will be so arranged as to cause pressure on the 
lumbar region as soon as the supine position is as- 



238 DIGEST OF EXTERNAL THERAPEUTICS. 

sumed. About two hours after sleep the patient 
should be awakened, as it is at this time usually the 
discharge of urine occurs. 

At bedtime, a Warm Bath at 90° to 98° F., or a 
Warm Sitz Bath or Cold Sponging of the lumbar re- 
gion is often of value. Open air Exercise and Cold 
Baths every morning should be enjoined. 

Children troubled with urinary incontinence should 
be taught to retain their water during the day as 
long as possible. (Rd.) 

General Massage, sponging with alcohol and wa- 
ter 1-6, Friction with coarse towels, and Sea Bath- 
ing are beneficial. 

Nux Vomica: — An ointment of 1 part of tne ex- 
tract with 16 of lard. A portion the size of a coffee 
bean inserted into the rectum at night often acts 
well. (Jac.) 

Electricity: — The interrupted current, one electrode 
to the perineum, the other to the epigastrium or lum- 
bar region. (Erb.) 

Collodion: — Applied over the meatus sealing it, has 
been used, though it is scarcely to be recommended. 

Strychnine: — Occasionally subcutaneous injections 
into the perineum of 4V— ro grains have been effective 
in intractable and desperate cases. (Jac.) 



EPIDIDIMITIS. 

Rest and Suspension of Scrotum is the first essen- 
tial. When the onset of the disease is announced by 
pain in the perineum, dragging sensation in the in- 
guinal region and frequent urination, a Hot Bath 
should be administered and the patient put to bed 
with the testicles properly supported. (CI.) 



EPIDIDIMITIS. 239 

Aspiration or Puncture of the Tunica Vaginalis: — 
This is indicated when the pain is intense ; in severe 
forms of inflammation it affords immediate relief. 
The sac will fill up again, requiring a repetition of the 
operation, to which the patient will readily assent, 
so great is the comfort afforded by this measure. 
Antiseptic precautions are enjoined. After the punc- 
ture, and also when it has not been performed, the 
scrotum should be wrapped in cotton, covered with 
oiled silk, and placed in a shallow suspensory band- 
age with lacers, so that equal pressure may be main- 
tained. (CI.) 

Tobacco and Flaxseed Poultice: — Applied every 
three hours, completely enveloping the scrotum, and 
covered with oiled silk and flannel, is useful. (CI.) 

Harriamelis: — The tincture applied hot in the same 
manner as the poultice affords great relief. (CI.) 

Ice: — The usual ice bag or bladder will act satisfac- 
torily for the relief of pain and inflammation. 

Ethyl Chloride also relieves and reduces inflamma- 
tion. (F.) 

Mercurial Ointment: — Alone or mixed with equal 
parts of Extract of Belladonna made into a paste, 
after the acute and painful symptoms have subsided 
for the reduction of swelling. (CI.) 

Ammon. Chloride: — ^ss— Oj, for reduction of swell- 
ing in the latter stages. (Al.) 

Nitrate of Silver: — 10 grs to the oz. in the form 
of an ointment is sometimes used. (CI.) 

Strapping: — When the pain has ceased this is indi- 
cated for the reduction of swelling ; pain sometimes 
follows its application, but it usually disappears in 
an hour or two ; if it continues the straps should be 
removed, for in this case they are too tight. The fol- 



240 DIGEST OF EXTERNAL THERAPEUTICS. 

lowing is the method of application : First remove 
the hair from the scrotum and render the parts 
aseptic, then cut strips of adhesive plaster an inch 
wide and 6—8 inches long. The spermatic cord about 
the swelling is encircled with the left hand, and the 
tumor pressed well down intothe scrotum, rendering 
the walls tense and firm. A piece of muslin bandage 
is now carried twice around the part involved at the 
upper border, and fastened at the end by a piece of 
adhesive plaster. The muslin prevents the adhesive 
straps from cutting. The straps are now applied, 
encircling the upper part of the scrotum, overlapping 
one another from above downward, until a little be- 
low the centre, when the direction is changed and 
carried under the scrotum, bringing the pendulous 
parts upward. A single strap to hold the ends will 
complete the dressing. After which a suspensory 
bandage should be put on and the patient permitted 
to go about. (CI.) 



EPILEPSY. 

(See Convulsions.) 

EPISTAXIS. 

Ice should be applied to the forehead and back of 
the neck, and a small piece inserted up the nostril ; 
raise the arms above the head and hold them there 
for a short time; press horizontally on the cheek 
bones with the fingerrs just above the nostrils, and 
so compress the blood supply. Immerse feet and 
legs in hot water. (Bt.) The patient should sit up- 



EPISTAXIS. 241 

right, and grasp the nostrils tightly between the 
thumb and index finger, so as to prevent the passage 
of air. Compress the facial artery and resort at 
once to tampons if haemorrhage becomes dangerous. 
(Whar.) 

Tannic Acid or Alum: — In powder by insufflation 
or solution by atomizer are both very useful. (Bo's.) 

Agaricus Chirurgorum: — Used for plugging the nos- 
trils. (F.) 

Antipyrin: — 20—50 per cent, as spray or the pow- 
der by insufflation . (Bn.) 

Hot Water: — Of service when atrophic rhinitis 
exists. (Al.) 

Nitrate of Silver: — When a small abrasion or ulcer 
is the cause, which is accessible, touch the part with 
a strong solution. (Al.) 

Hydrogen Peroxide: — Injections into nostril full 
strength, is said to be very effective ; or a plug of 
cotton saturated with the remedy may be inserted 
into the nostril. (T. 98.) 

Iodoform Gauze dipped in Glycerite of Tannin and 
used as a tampon is effective. (T. 96.) 

Cocaine: — One of the most reliable remedies. It 
may be applied on pledgets of cotton carried well into 
the nasal cavity, or better in the following applied 
with the atomizer : 

Cocainae Hydrochlor. , grs. xx. 

Aq. Destill., £ss. 

M. Ft. sol. et adde 
Ol. Voschano, 
Vel. 01. Petrolati, vel 01. Olivae, ad. gi. (Bos.) 

Zinc Sulphate: — The powder or stronger solution 
of about 40 per cent. (F.) 
The following are also recommended for applica- 

i7 



242 DIGEST OF EXTERNAL THERAPEUTICS. 

tion in the form of sprays, or on little mops of cotton, 
or in more severe cases on tampons : 

Tr. Hamamelis; Tr. Perchloride of Iron; Liq. Ferri 
Sulph., 3i, Water, ^viii; Vinegar or Acetic Acid, 1 
part to 5 of water. (Rd.) (B.) (Al.) 

Tamponing the anterior and posterior nares at 
the same time, after the usual method described in all 
surgical works, is necessary in severe cases. A soft 
rubber catheter, however, is preferable to Bellocq's. 
(Jac.) 

Plugging with Small Sponges: — This may be done 
in the following manner : Introduce into the interior 
nares a small piece of sponge, tied to a short silk lig- 
ature ; push it back along the floor of the nose to the 
posterior nares; a small piece of sponge about the 
size of a marble, with a hole in the centre of it, is then 
threaded on the ligature through the hole ; it is then 
pushed backward until it comes in contact with the 
first piece. Then another is introduced in the same 
way, and so on until the cavity is completely filled up 
and the haemorrhage arrested. The sponges should 
be rendered thoroughly aseptic, and should also be 
washed in some antiseptic solution. They may re- 
main in from twenty-four to forty-eight hours. 
(Whar.) 

Cauterants: — The galvano-cautery or chromic acid 
crystals on a silver probe may be used when the pa- 
tient is not bleeding, but has recently done so. By 
throwing a strong light up the nostrils the affected 
parts may be seen and touched. (T. 97.) The gal- 
vano-cautery is condemned by Bosworth, who says 
when the bleeding points can be located a crayon of 
nitrate of silver or a crystal of chromic acid will 
usually answer the purpose, and if these fail an ordi- 



EPITHELIOMA. 243 

nary silver probe heated to a dull heat over a spirit 
lamp will take the place of the galvano-cautery, at 
the same time being very much more available and 
more easily applied. 



EPITHELIOMA. 

Extirpation by the knife is favored by most sur- 
geons, who advocate its performance in all cases 
when practicable except those of the most superficial 
nature, early removal being regarded as a matter of 
urgent necessity. Dermatologists, on the other 
hand, incline decidedly to the use of caustics, reserv- 
ing operative measures entirely for those parts where 
it is possible to remove a large amount of tissue 
without injury to the patient. Caustics they also re- 
gard as more certain of success and productive of less 
deformity. 

From the surgeon's standpoint there are two 
classes of cases in which non-operative treatment is 
of service ; those in which the lesion, as first men- 
tioned, is of a most superficial character, and where 
such treatment is often successful; and those in 
which operative measures are absolutely refused, or 
where from the nature of the case they are not 
deemed advisable. 

Non-operative treatment should aim at the com- 
plete destruction of the diseased tissues and no super- 
ficial caustics should ever be used, for they do more 
harm than good. 

The following are some of the most important 
methods suggested for the local treatment of this dis- 
ease: 



244 DIGEST OF EXTERNAL THERAPEUTICS. 

Arsenious Acid:— This agent holds the first place 
among escharotics and forms the basis of several 
w ell-known pastes. 

Arsenical pastes should have the consistency of 
firm butter ; the strength and duration of applica- 
tions will vary according to the character of the can- 
cer. Hardaway says he regulates the strength ac- 
cording to the case, never making it weaker than 
equal parts, or stronger than Marsden's. The same 
writer also says that the desired action must be ob- 
tained, otherwise the patient is injured. Antiseptic 
dressings are not necessary, as the toxines from the 
pus organisms are of service in destroying patholog- 
ical epithelia. (B. H.) 

Marsden's Paste: — Composed of 2 parts of "ar- 
senious acid to 1 of gum acacia rubbed together 
and made into a paste with water which is added 
just before applying. It is exceedingly painful and 
causes oedema. It must be left on for twelve to 
twenty-four hours, according to the endurance of the 
patient. The application must be repeated if the 
grow T th is not destroyed. Poultices are continually 
applied after the removal of the paste until the slough 
separates. (Kp.) 

Manec's Paste: — This has stood the test of time. 
(See Cancer, under arsenious acid, for formula.) Be- 
fore application, the diseased part must be thoroughly 
cleansed of all crusts and detritus by the use of poul- 
tices, etc. Then the paste is to be spread on lint and 
closely fitted and held firmly in place by plasters. 
The applications must be kept up for one or two 
weeks, at the end of which time the eschar falls off. 
(For the other arsenical preparations of this nature 
see Cancer.) 



EPITHELIOMA. 245 

Caustic Potassa: — According to Van Harlingen this 
remedy never fails to remove superficial growths 
when properly applied. A stick of the potassa is 
wrapped in a rag, leaving the point exposed. This is 
first passed over the surface gently, in order to dis- 
solve the horny epithelia ; afterwards it is bored 
down into every part of the growth. When apply- 
ing it wall be seen that the unhealthy tissues readily 
gives away. The action of the caustic being always 
a little beyond the point of actual contact, this fact 
must be taken into consideration when operating 
near important organs. Severe pain will be caused 
which may be neutralized by the application of a 4—8 
per cent, solution of cocaine. Dilute acetic acid or 
weak vinegar should be applied with cloths, to neu- 
tralize the caustic influence when it has gone far 
enough and also to lessen the pain. The part should 
be dressed with olive oil or some soothing ointment 
and changed daily. At the end of a week or ten days 
the eschar falls off. After which a rapidly granulat- 
ing surface appears, which leaves only a small scar 
after healing. 

Methyl Blue: — Solutions of 1-20, hypodermically, 
when the growth is deep seated. (T. 96.) 

Pyrogallic Acid: — This remedy is considered by 
many observers as the best; it has the advantage of 
being almost painless ; 1 drachm to the ounce is the 
usual strength of its application, which should be 
continued consecutively for from two to six days. 
It wall have to be reapplied from time to time and 
the slough scraped away. (F.) 

Citric Acid: — A lotion for the relief of pain is made 
from a solution of 5—6 grains to 1 oz. of w^ater. (Al.) 

Schwimmer's Treatment: — This is adapted to su- 



246 DIGEST OF EXTERNAL THERAPEUTICS. 

perficial epithelioma, and to some forms of the infil- 
trating variety. The growth is scraped out thor- 
oughly with a dermal curette, the diseased tissues 
readily giving way. Haemorrhage should be stopped 
by pressure. After curetting pyrogallic acid in an 
ointment (1-2 parts of base) is applied for four 
or six days. The ointment produces a black crust 
and free discharge ; at the end of the four to six 
days this should be softened by applications of car- 
bolized vaseline left on for a day or two. After its 
removal apply mercurial plaster, under which the part 
will heal. (Ja.) 

Zinc Chloride: — Though rarely indicated is some- 
times employed in solution, paste, or stick. It de- 
stroys both normal and diseased tissue, though not 
in equal degree. It may be used in papillomatous 
growths until the base is reached, then another caus- 
tic should be used. Solutions of this agent may be 
injected into small tumors, where arsenious acid and 
caustic potassa cannot be used. 

The formula known as Bongard's Paste, which is 
usually employed, is as follows : 

Farinae Tritici (Wheat Flower), 

Amyli, aa ^i. 

Pulv. Acid. Arseniosi, grs. viii. 

Hydrarg. Sulph. Ruhr., 9ii. 

Amnion. Chloiid., 9ii. 

Hydrarg. Chlor. Corros., grs. iv. 

Zinc. Chlorid., Cryst., Ji. 

Aq. Fervid., ^i ss - 

This paste is spread on muslin and left on for twenty-four 
hours. If the application is successful all the diseased tissues will 
appear necrosed. When the growths are large, several applications 
are necessary. (B. H.) 

(For other preparations of this remedy see Cancer. ) 
Lactic Acid: — A powerful caustic. Equal parts 



ERYSIPELAS. 247 

mixed with finely powdered silica are spread on gum 
paper and allowed to remain on from twelve to 
twenty-four hours. (Ja.) The concentrated acid has 
also been used applied on cotton cloths and covered 
with an impermeable tissue and bandage. The sur- 
rounding skin should be protected with adhesive 
plaster. After the removal of the caustic, the part 
should be cleansed with cold water and dressed with 
water dressing for from twelve to twenty -four hours. 
(N.) 

Nitric Acid: — 10 parts of the fuming acid with 4 of 
perchloride of mercury, made in a syrup by the addi- 
tion of bibulous paper, is said to form a good caustic 
which will leave excellent cicatrices. (T. 96.) 

Chloracitic Acid: — This is less suitable than 
stronger eschar otics, but will be of service when the 
disease is close to some important organ, as the eye, 
where the influence of the caustic must be circum- 
scribed. Its action not being deep, applications must 
be repeated at intervals ; a stick or probe covered 
with cotton may be used. (Al.) 



ERYSIPELAS. 

A great varietj^ of local remedies have been advised 
for this affection, many of which are not only unnec- 
essary, but of questionable utility, especially in the 
milder types, when only the simplest applications, if 
any, will be required. 

As the exclusion of air from the surface is grateful, 
the part should be covered with a light dressing, and 
when the face is the seat of the affection a light linen 



248 DIGEST OF EXTERNAL THERAPEUTICS. 

or muslin mask, saturated with the selected remedy, 
may be worn with benefit. 

Cold Water Dressings: — Suitable for mild cases, 
forming an important and useful adjuvant ; they 
should be changed frequently. (Gn.) After mention- 
ing a number of applications, Osier adds that perhaps 
these dressings are as good as any. 

Carbolized Olive Oil: — 1 per cent, for facial erysip- 
elas. (Den.) 

Ichthyol: — The most highly praised of all remedies. 
It is used in various combinations. Before applying, 
the affected part should be cleansed with soap and 
water, then washed with a solution of bichloride of 
mercur}' ; the ichthyol preparation should then be 
thicklv spread on and covered with cotton batting. 
(Al.) ' 

A 50 per cent, ointment with lanoline is recom- 
mended by Unna, covering after with salicylated cot- 
ton. It is claimed that it arrests the progress of the 
disease. (T. 96.) 

With Collodion, Unna has found the following pig- 
ment of service : 

Ichthyol, 

Ether, aa £ss. 

Collodion, %i. (Al.) 

With Traumaticine it is said to have aborted 60 
per cent, of cases. The proportions are ichthyol 3 
parts, traumaticine 10 parts ; this combination, 
which makes a dark brown liquid, should be applied 
to the diseased area with a brush, and at least three- 
quarters of an inch beyond. (P.) 

The remedy is said to be indicated in all varieties 
of the disease. (Sj.) 

Lead and Opium Wash: — This old fashioned rem- 



ERYSIPELAS. 249 

edy is still regarded as one of the most effective. It 
is useful to allay the burning. Use Laudanum, 2 
parts, and Liq. Plumbi Diluti (U. S. P.), 4 parts. (Ty.) 

Trichlorphenol: — 1-2 per cent, ointment is very 
effective. (F.) 

The following solutions are recommended applied 
with cloths saturated with the same : 

Boric Acid, saturated solution. (St.) 

Carbolic Acid, 1 drachm with half a pint each of 
alcohol and water, applied every alternate hour (Ja), 
or half a drachm to a pint of milk ; the latter is said 
to greatly relieve. (Rd.) 

Borax, gss— Oss. (Hel.) 

Picric Acid, 6-1000. This remedy has been highly 
praised. (F.) 

Grindelia Robusta, 2 drachms of the fluid extract 
with water half a pint. (Al.) 

Resorcin, 2 or 3 per cent, solutions. (F.) 

Hydrastis, 1 part of the tincture to 5-6 of water. 
(M. H.) 

Belladonna, 1 part of the tincture ; 1 part of gly- 
cerine; 8 parts of water, recommended by Piffard. 

(Ja.) 

Veratrum Viride, 1 drachm of the tincture; tepid 
water, 2 ounces, one of the best local remedies. (Ga.) 

Calamine lotion. (M. W.) 

Glycerite of Starch, forms an agreeable substi- 
tute for greasy preparations. (M. W.) 

Alcohol: — Cloths kept saturated and covered with 
some impermeable material. Reported to have been 
successfully employed in thirty-two cases, when dis- 
ease was situated on the face and other parts. (Sj.) 

Vaseline — For application to the face forms a con- 
venient dressing. (F.) 



250 DIGEST OF EXTERNAL THERAPEUTICS. 

Cosmoline: — Preferable when an ointment is used, 
as it interferes less with the function of the skin. ( Al. ) 

Benzoated Collodion, made with equal parts of 
the compound tincture of benzoin and collodion. 
(B.H.) 

Ferric Perchloride: — 1 per cent, solution in ether is 
said to act quickly in aborting. (T. 96.) 

Salicylic Acid: — ^ss— i with cosmoline gi has been 
employed with satisfactory results. (Al.) 

Bichloride of Mercury: — 1-1000 sprayed on the 
part at a distance of four inches, and repeated four 
times daily, has been successfully employed. In using 
this treatment the eyes should be protected and hair, 
if present, should be cut off. (Vn.) Solutions of 
1—5000 as a dressing have also been employed. (St.) 

Method of Koch: — Creolin 1 part, Iodoform 4 
parts, Lanolin 10 parts. Applied not only on the 
affected area but one inch beyond on healthy skin. 
(Al.) 

Method of Hollopeau: — A mask of several thick- 
nesses of linen is soaked in a solution of Sodium Sali- 
cylate 1—20, and applied over the part. A rubber 
cloth is put on over this to prevent evaporation. Re- 
lief, it is said, is almost immediate and cure rapid. 
(An.) 

Method of Wcefler: — A simple piece of adhesive 
plaster an inch in width and sufficient^ long to sur- 
round the part is applied an inch or more from the 
advancing border of the disease. The firmer the 
pressure the greater the chance of success, which is 
said to be very marked. This procedure is preferable 
to that of the Kraske-Reidel method. (B. H.) 

Carbolic Acid Injections: — 1-2 per cent, solutions 
are used for injections in the part surrounding the 



ERYSIPELAS, PHLEGMONOUS. 251 

diseased surface. This method is painful and liable 
to cause abscess ; at the same time it has been suc- 
cessful. (Os.) 

Pilocarpine: — J- grain hypodermically injected in the 
same manner as carbolic acid, until physiological 
effects are produced, has been used. (B. H.) 

Kraske-Reidel Method: — This consists of scarifica- 
tion partly in the healthy and partly in the diseased 
skin ; then the application of gauze wet with a solu- 
tion of bichloride of mercur}^ 1—1000. The method is 
painful and causes scars and therefore is not suited 
for use on the face. It is to be employed only for the 
more grave form of the disease and is not generally 
commended. (B. H.) 

Bichloride of Mercury Injections: — This procedure 
is only justifiable when the size of the area involved 
is not sufficiently great to require enough of the bi- 
chloride to endanger poisoning. The injections are 
made around the involved area. Wyeth says he has 
used a solution of 1—500 around an erysipelatous 
patch an inch in diameter without causing untoward 
symptoms. As the injections cause pain, local anaes- 
thesia is necessary. (W.) 

This method is adapted to severe forms of the dis- 
ease. 



ERYSIPELAS, PHLEGMONOUS-CEL- 
LULITIS. 

Free Incision and Drainage: — As soon as pus is 
formed, incisions should be made and drainage estab- 
lished. (Q.) Park says that the treatment of threat- 



252 DIGEST OF EXTERNAL THERAPEUTICS. 

ened phlegmon consists primarily in free incision 
down to the deepest tissue involved, even to the bone 
itself if necessary. (Pk.) After incision the parts 
should be cleansed and irrigated with an antiseptic 
solution. (Den.) 

Carbolic Acid and Hydrogen Peroxide: — Preferable 
in this disease for irrigation to solutions of corrosive 
subli mate. ( Den . ) 

Antiseptic Baths: — The immersion of the parts 
when possible in a bath of a hot weak antiseptic so- 
lution is beneficial. (Den.) 

Antiseptic Fomentations: — After incision large 
bora ted orcarbolized fomentations should be applied. 
(Tre.) 



ERYTHEMA SIMPLEX. 

Soothing and astringent lotions are indicated. 
The following are serviceable: 



Or, 



Or, 



Acid. Hydrocyanic. 


Dil., 


3*. 


Bismuth. Subnitrat 


• > 


3i-ii. 


Aq. Aurant. Flaw, 




Jiv- 


Pulv. Zinc. Carb. Praecipitat. , 




Pulv. Zinc. Oxidi, 






Pulv. Amyli, 






Glycerini, 




aa !£iv. 


Aquae, 




Oss. 


Acid. Carbolici, 




3ss. 


Zinc. Oxidi, 




3ii. 


Glycerini, 




3i- 


Aq. Rosae vel. L4q. 


Calcis, 


q. s. ad. ^viii 



(Vn.) 



(B. H.) 



ERYTHEMA INTERTRIGO. 253 

Dilute Lead Water or Lead Water and Lauda- 
num, or Alcohol and Water are also useful in many 
cases. Powders are difficult to keep in contact with 
the skin, and ointments, as a rule, do not agree. 

Alkaline Baths are sometimes serviceable. 

Zinc Acetate: — Grs. ii, rose water gi, recommended 
by Tilbury Fox. (Al.) 

Bismuth Subnitrate, Zinc Oxide, with equal parts 
of Starch or Lycopodium powder or Talc, as dust- 
ing powders. (Bt.) 



ERYTHEMA INTERTRIGO. 

Cleanliness is the most important feature of treat- 
ment. Wash the parts with a little Castile soap and 
water, dry with a soft towel and apply mild dusting 
powders such as Starch, Lycopodium or equal parts 
of the latter with Zinc Oxide or Buckwheat Flour, 
Bismuth, Subnitrate or Boric Acid. 

McCall Anderson's Powder: — A ver}^ useful com- 
pound. It is composed as follows : 

Pulv. Camphorae, 3i~ii- 

Pulv. Amyli, 

Pulv. Zinc. Oxidi, aa §ss. 

It is important that the camphor should be an impalpable pow- 
der, and that the bottle should be kept tightly corked. ( Al. ) 

Belladonna: — When the thighs and genitals are the 
seat of trouble, and there is some hyperhidrosis, the 
tincture may be painted on, followed by powdered 
zinc oxide. (Vn.) 

Lotions are suited to cases of a more obstinate 
character. The following will prove satisfactory : 



254 DIGEST OF EXTERNAL THERAPEUTICS. 

Lotio Nigra: — Applied several times a day followed 
by dusting powders. (Vn.) 

Alum and Zinc Sulphate: — Recommended by the 
late Dr. Tilbury Fox as follows : 

Zinc Sulphate, grs. x. 

Alum, grs. xx. 

Glycerine, %{. 

Rose Water, £iv. ^Al.) 

Bland ointments may be of service such as Zinc 
Oxide 1 drachm with Ung Aq. Rosse, gi. (B. H.) 

Cerates or glyceroles of Calendula, Iodoform, 
Zinc Oxide, Hydrastine, Boric Acid, Carbolic Acid, 
etc. (Bt.) 



FAVUS. 

Great patience and perseverance are necessary for 
the successful treatment of this obstinate disease. 

The hair should be cut short, after which all crusts 
may be removed with poultices and oil or hot water 
and soap, as in pustular eczema. Then epilation 
should be practiced, pulling the hair out not only 
from the patches, but also for about half an inch 
around them; this should be repeated every week un- 
til no trace of redness exists. (Ja.) After this the 
scalp is ready for a parasiticide. The following are 
of service : 

Heat: — The disease being sensitive to high temper- 
ature the following has proved successful. Com- 
presses wet with a bichloride of mercury solution 1— 
1000, are applied to the part, and over this a series of 
Leiter's tubes through which hot water at a temper- 
ature of 140°— 150° F. is run. Applications may be 



favus. 255 

continued for twelve hours daily for eight days. (Sj.) 

Chrysarobin: — 10—20 grains with lanoline, 1 
ounce, forms one of the most effective applications. 
(B.H.) 

Tr. Iodine : — Freely applied, recommended by 
Besnier. 

Resorcin: — Used by Crocker, 1 drachm with 1 oz. 
of lanoline or oil. 

Method of Besnier and Doyon: — The following 
line of treatment is recommended : 

Cut off the hair around the patches ; then cover the 
whole head with equal parts of soft soap and lard, 
allowing this to remain two or three hours ; then 
wash off with warm water and cover the head during 
the night with a rubber cap. The following morning 
the head is washed clean and bathed with a solution 
of boric acid 25—1000, and covered with borated lint 
soaked in the following : 

Sodii Salicylate 25 parts. 

Sodii Bicarbonat. , 10 parts. 

Aquae, 1000 parts. 

Over this the rubber cap is placed. After a few days the scalp 
will be clean and the dermatitis will have disappeared. Epilation 
must now be practiced, the hair being extracted from the patches 
and for an inch around them. The head to be kept covered with 
the rubber cap. In the evening an antiseptic ointment such as 

Bal. of Peru or Oil of Cade, 2-5 parts. 

Salicylic Acid, Resorcin, each, 1-5 parts. 

Sulphur Precipitate, 5-15 parts. 

L,anolin, Vaseline, Lard, equal parts of each to make 100. 
Then each patch is to be covered with mercurial plaster. (Ja. ) 

Every morning, wash the scalp with tar soap, soak 
each fa vie patch with the following . 

Alcohol, 90 per cent., 100 parts. 

Acetic Acid (Crystals), % to 1 part. 

Boric Acid, 2 parts. 

Chloroform, 5 parts. 



256 DIGEST OF EXTERNAL THERAPEUTICS. 

The following other applications are recommended: 

Salicylic Acid, 3—5 per cent., Carbolic Acid, gtts. 
xv— 3-gi of Olive Oil, Naphthol Oil, 1 per cent., 
Sodium Hyposulphite, ^ii-gi. (B. H.) 

Naphthol 5 per cent, ointment (B.) Hydrarg. Oxid. 
Flav. 3ss-3i, Ung. Sulphur, Sulphurous Acid, satur- 
ated solution . ( Vn . ) 

Resorcin, Mercurial or Hydronaphthol Plasters 
are to be used for constant application to favus of 
the nails. (Ja.) 

When situated on non-hairy parts the disease 
usually yields to the application of antiparasitic 
ointments such as those mentioned. 

After apparent cure the patient should be carefully 
watched, and any red point that appears is evidence 
that the disease is returning, and that treatment 
should be at once resumed. 



FELON. 

Alkalies: — A poultice of hard wood ashes, will 
often abort. ( F.) 

Nitrate of Silver: — A strong solution in Nitric Acid, 
will abort if applied early. (B.) 

Ichthyol:— Equal parts with water, has been used 
with excellent results. (Al.) 

Leeches may be applied above the nail in the early 
stages with good effect. (Ag.) 

Ung. Hydrarg. : — Applied for ten minutes every hour 
with poultices at other times. (R.) 

Iodine:— Will often abort if applied as soon as slight 
pain is felt. Paint the finger freely, or dip it into the 
fluid and allow it to dry on; repeat this three or four 
times a day. (Al.) 



GALACTORRHEA. 257 

Nitric Acid: — Painting the affected part with the 
fuming acid is said to relieve the pain instantly. (Rd. ) 

Citrine Ointment: — Has been used with success. 
(Al.) 

Alcohol: — Serviceable in neglected cases when poul- 
tices have been long used ; equal parts with water 
form a convenient evaporating lotion. (Al.) 

Heat: — Fomentations and dipping the finger in hot 
water will afford relief of pain and hasten suppura- 
tion. (Bt.) 

Lobelia: — A saturated compress of the tincture 
kept constantly applied is said to be efficacious in 
arresting. (Hel.) 

Free Incision is imperative when pus has formed 
beneath the tendons or periosteum ; its neglect will 
entail much pain and possibly loss of the finger. (Hel.) 



GALACTORRHEA. 

Hot Cloths applied for ten minutes and repeated at 
intervals. (G. J.) 

Pressure: — Cover the nipple with sterilized gauze 
and apply a firm binder ; the breasts will then empty 
themselves. (G. J.) 

Camphorated Oil rubbed on will often control the 
condition. (F.) 

Conium: — An ointment of the bruised leaves, may be 
employed when it is desired to dry up the milk. (Sm. ) 



GANGLION. 

Method of Duplay: — Wash and disinfect the skin as 
for an operation, then inject 5-6 drops of Iodine 
into the cyst, the skin being drawn aside so as to 



258 DIGEST OF EXTERNAL THERAPEUTICS. 

form a valvular opening; the contents are now evac- 
uated and an antiseptic dressing and pressure are ap- 
plied. The pain is slight, and a cure is generally 
affected in from five to six da} r s. In large c} r sts a 
second injection is sometimes necessary. The syringe 
should be rendered aseptic. This method is described 
as safe, simple and invariably successful. (T. 96.) 

Subcutaneous Rupture: — Striking the cyst a blow 
is a time-honored procedure. (Pk.) 

Other methods are, Subcutaneous Division by a 
small flat needle and Injections of Iodoform. (Mc.) 
Whatever method is employed pressure and the use 
of splints are recommended. (Pk.) 



GANGRENE. 

MOIST GANGRENE: 

Apply cotton batting several inches thick around 
the part, and cover with oiled silk or rubber protect- 
ive ; care should be taken that there is no pressure. 
Hot water bags and bottles are deprecated on account 
of the capillary contraction these agents produce. 
As death of the part progresses all disorganized tis- 
sues which can be easily removed should be cut away 
■with the scissors, and an antiseptic dressing applied, 
such as gauze soaked in sublimate solution 1—500. 

(W.) 

Carbolic Acid, 1 part, glycerine 4 parts; lint soaked 
in this solution and applied to gangrenous surfaces 
was used by Lister. The following has been found 
effective : 

Carbolic Acid, 752 grs. 

Caustic Soda, 124 grs. 

Water, Oj 



GANGRENE. 259 

Lint soaked in one part of this mixture with four 
of water and kept constantly applied, covering with 
oiled silk, will be found effective in relieving the pain 
and destroying the fetor. The solution may be made 
more dilute if desired. (M. H.) 

Hydrarg. Bichlorid.: — The stronger solution may be 
employed for cleansing. Gauze soaked in a solution 
of 1—1000 should be laid around the line of demarca- 
tion as soon as formed to guard against septic ab- 
sorption. (W.) 

Poultices of linseed meal, charcoal, yeast or carrots 
are sometimes of service in removing sloughs. (Bt.) 

Free Incisions : — Indicated in phlegmonous or 
other inflammations when the tension is so great that 
gangrene is threatened by pressure upon the capilla- 
ries and large vessels. The incision should be made 
parallel with the vessels and sufficiently deep to re- 
lieve tension. (W.) 

Iodoform and Salicylic Acid: — Among the most 
effective of the dusting powders after the removal of 
sloughs to promote healtlry granulations. (B.) 

Peat, finely pulverized, sprinkled over gangrenous 
surfaces has been highly praised. (F.) 

DRY GANGRENE: 

The affected part should be wrapped in cotton and 
placed in as comfortable a position as possible. (W.) 
If any local treatment is required that mentioned un- 
der the moist variety is applicable. 

HOSPITAL GANGRENE: 

As soon as attacked the wound should be immedi- 
ately mopped with some escharotic, the most effective 
of which are the following : 

Bromine: — This agent heads the list and is to be 



260 DIGEST OF EXTERNAL THERAPEUTICS. 

generally preferred to all others (F.); it proved to be 
most efficacious in the war of the rebellion. If the 
disease has progressed for two days, and the wound 
is covered with the pulpy mould peculiar to the mal- 
ady, it should be scraped first with a Volkmann's 
spoon and mopped with the bromine. When the skin 
has become undermined, free incision should be made 
so as to expose every part to the action of the caus- 
tic, and afterwards dressed with iodoform gauze. In 
the case of a gun-shot wound the entire track must 
be scraped out with a piece of cotton immersed in 
bromine and fastened on a holder. Anaesthesia is 
necessary. (W.) 

Nitric Acid: — Also excellent; ranks next to bromine. 

Chromic Acid: — Highly effective; it penetrates the 
tissues deeply, causing comparatively little pain. 

Zinc Chloride and the dried Sulphate: — The pow- 
ders are both powerful caustics, but the fact that 
they cause great pain should be remembered. (B.) 

Turpentine: — One of the oldest and most efficient 
applications ; the mortified parts are first removed 
with the scissors and the remedy is applied directly 
by means of cotton cloths saturated with it. Fetor 
is removed and sloughing arrested, and but little pain 
ensues. (B.) 

Citric Acid: — Lemon juice dropped into gangrenous 
wounds which are then covered with lint steeped in 
a solution of chlorine is said to have good effect. (Pt.) 

Resorcin: — A 2 per cent, solution is reported to 
have succeeded in arresting when other measures 
failed. (Al.) % 

Camphor: — The powder, freely sprinkled over flax- 
seed and charcoal poultices, has been used for the 
sloughing surfaces both in this form and senile or dr\^ 
gangrene. (Al.) 



GASTRALGIA. 261 

Potass. Permang.: — Grs. iii— x-^i (B.), and Labar- 
raque's solution, (N.) both form useful dressings to 
correct the fetor. 

Warm Baths: — For gangrenous ulcerations the im- 
mersion of the part continuously for about eight 
hours in a warm water bath, temperature of 95°— 
98°, was introduced by Hutchinson. After two or 
three sittings the sores are said to assume a healthy 
appearance. (Al.) 



GASTRALGIA. 

Lavage has been productive of good results in cases 
which have resisted other therapeutic measures, espe- 
cially those which have resorted to morphine; the 
water used warm has a soothing effect. (S. B.) 

Warm Baths every night for ten minutes and 
Faradism of the stomach should be combined with 
lavage. (S. B.) 



GASTRITIS. 

Lavage: — Is of service in chronic gastric catarrh 
with excess of mucus, and in no other condition has 
it done so much good. (Ew.) Several quarts of water 
may be used, but not more than one pint should be 
introduced into the stomach at once. The morning, 
before breakfast is usually the best time for adminis- 
tration, but when the mucus collects to a large 
amount the stomach may be washed out again be- 
fore dinner, directing the patient to take a light 
luncheon. (S. B.) 



262 DIGEST OF EXTERNAL THERAPEUTICS. 

Lavage with Nitrate of Silver: — This is of value in 
long standing cases of catarrh with hyperacidity. 
The stomach is first washed out with a weak solu- 
tion of bicarbonate of soda, in order to remove the 
excess of mucus, then with a warm solution of ni- 
trate of silver, 20 grains to the quart. Finally 
the organ is douched repeatedly with a solution 
of chloride of sodium, 45 grains to the quart. Under 
this treatment the digestive power of the stomach in- 
creases and the vomiting and constipation disappear. 
(T. 98.) 



GINGIVITIS, SIMPLE. 

Antiseptic Tooth Wash: — Night and morning, or 
better after each meal. 

Cleanliness: — The absence of cleanliness is often 
the cause of inflammation in children ; hence after 
nursing the mouth should be washed and patient 
should be given a little water to drink. (Jac.) 

Nitrate of Silver: — 1—500 or 1000 brushed on once 
a day when mucous membranes are dry ; recom- 
mended for children. (Jac.) 

Copper Sulphate: — The powder packed down under 
the edge of the gums with a wooden point for sev- 
eral days ; then use as a mouth wash : 

Potass. Chlor., ^ii. 

Sod. Biborat., £i. 

■ Potass. Nit., 3ss. 

Tr. Arnicae, £ii. 

Aq. Rosae, ad. ^viii. (T. 96. ) 

Removal of Tartar: — Tartar must be most carefully 
scaled off ; then syringe under the gums with hydro- 
gen peroxide. (T. 96.) 



GLANDERS. 263 

Zinc Chloride: — If the tissues are turgid, thickened 
and inflamed, apply with syringe 20 per cent, solution 
under edge of gums. (T. 97.) 

A useful powder : 

Cretse Prseparat., ^i y - 

Pulv. Radicis Iridis, 3 iii. 

Pulv. Saponis Alb. , 3vi. 

Ol. Eucalypt., 3 ss. 

Otto Rosae, Mvii. 

If there is much destruction of tissue apply every 
four days with a brush the following : 

Ol. Cinnamon., £iv. 

Ol. Gaultheriae, 3iv. 

Acid. Carbolici, £i. (T. 96.) 

GLANDERS. 

Excision, Curettage and Cauterization in the cuta- 
neous form should be practiced as early as possible, 
following with antiseptic dressings. (Pk.) All sus- 
picious wounds and all ulcers should be freely cau- 
terized. (Q.) 

As abscesses form they should be evacuated by free 
incision and cleansed constantly with antiseptic in- 
jections of Potass. Permang. or Carbolic Acid. (Vn.) 

For nasal ulceration, Iodoform and the allied dust- 
ing powders; sprays of Bichloride of Mercury, Car- 
bolic Acid and Hydrogen Peroxide. (Ty.) Nitrate 
of Silver solutions or Tincture of Iodine may be used 
for touching the ulcers. (Vn.) 

GLANDS ENLARGED. 

(Compare Adenitis.) 

Iodine: — Parenchymatous injections with a hypo- 
dermic syringe are often exceedingly valuable, a few 
drops of the tincture being sufficient. (F.) 



264 DIGEST OF EXTERNAL THERAPEUTICS. 

Carbolic Acid: — 2 per cent, solution injected into 
the glands which threaten to suppurate will often 
prevent the formation of pus. (Sm.) 

Iodoform: — The officinal ointment useful in many 
forms of enlargement. 

Cadmium Iodide: — The ointment, grs. x— xx— ^i, in 
chronic enlargements. (Sm.) 

Ichthyol: — As an ointment, ^iii— |i, was recom- 
mended by Agnew. 

Zinc Iodide: — 31 — §i, as a simple ointment. (Sm.) 

Mercury: — The ointment of the red oxide often 
has striking effect in reducing simple hypertrophy of 
the thyroid gland, enlarged spleen, or ague cake. 
(B.) Calomel, si; morphia sulphate, grs. i— iii— gi of 
base, is useful in reducing swelling and arresting ab- 
scess. (Sm.) 

Conium: — The ointment is useful in reducing scrof- 
ulous glands, enlarged mammary glands, enlarged 
liver and spleen and goitre. (Sm.) 

Galvanism: — Often of service in reducing chronic 
enlargement of cervical gland ; the current may be 
medicated with iodine or ammonia chloride. The 
positive pole is placed on the back of the neck and 
the negative over on the gland. Rapid resolution, it 
is claimed, will take place. (Terry.) 

The care of the teeth is very important. Carious 
teeth are often the means by which the tubercular 
bacilli gain an entrance and cause tuberculosis of the 
cervical gland. Of 100 cases in children, 41 per cent, 
originated from this cause. (T. 97.) 

TUBERCULOUS GLANDS: 

Unless the primary sources of infection are treated, 
recurrence is certain. If the gland is softened and 



GLEET. 265 

practically analogous to a tuberculous abscess, the 
following: (1) Incision large enough to admit the 
finger; (2) scraping throughout with Yolkmann 
spoon; (3) application of pure carbolic acid; (4) 
stuffing with iodoform worsted. (T. 97.) 



GLEET. 

In not a few cases of chronic urethritis, local meas- 
ures are contra-indicated, as frequently the prolonged 
use of injections and balsamic preparations tend to 
perpetuate the gleet ; in others, however, local appli- 
cations in conjunction with treatment directed to- 
wards the improvement of the general health are of 
great advantage. Restoration of the normal calibre 
of the urethra, the cure of the catarrh and the heal- 
ing of localized areas of inflammation are the essen- 
tial points in the treatment of this condition. (W. M. ) 

The first step is to examine the urethra and thus 
ascertain if possible the local cause of the difficulty. 
For this purpose the bulbous flexible French bougies 
or the endoscope may be used. 

Chronic urethral inflammation is divided into ante- 
rior and posterior chronic urethritis. 

Local Treatment for Anterior Chronic Urethritis : 
Meatotomy: — When the meatus is contracted, that 
is, will not admit of the passage of a sound the nor 
mal size of the urethra, the contracted condition will 
often act as a source of irritation and perpetuate the 
diseased condition. Meatotomy is then advised, fol- 
lowed by flushing of the canal with mild antiseptic 
solutions and the passage of a sound. To be re- 



266 DIGEST OF EXTERNAL THERAPEUTICS. 

peated eA^ery two or three days, according to the 
amount of reaction. Cure under these conditions 
may usually be expected in from two to six weeks. 
(W. M.) 

Nitrate of Silver: — Is the most valuable, 10 drops 
of a 1 per cent, solution every third day, increasing 
the strength up to 5-10 per cent., very exception- 
ally the latter. It is most effective in solutions from 
1—5 per cent, and is especially indicated when there is 
discharge from the posterior part of the urethra with 
urgent desire to urinate and pain on orgasm. (W.M.) 

Iodine and Carbolic Acid: — Equal parts of a 1 per 
cent, solution of each up to 10 per cent, solutions 
may be tried when silver fails. (W. M.) 

Strong Caustic and Astringent applications are 
recommended when other measures have failed. It is 
absolutely essential to determine the precise location 
of the diseased area, and to apply the remedy with 
caution, taking care not to leave an excess of the 
caustic fluid on the mucous membrane. Nitrate of 
Silver fixed upon the end of a blunt probe and 
touched cautiously to the spot, or a solution of Sul- 
phate of Copper, grs. xxx— 3i— £i, may be thus em- 
ployed. (B. H.) 

In some cases the endoscope, although apparently 
indicated, gives negative results or aggravates the 
condition ; under these circumstances injections or 
dilatation should be substituted. (W. M.) 

Local Treatment for Posterior Chronic Urethritis. 

When the inflammatory condition has extended to 
the posterior portion of the urethra, deep injections 
or irrigations are necessary. The instrument of 
Ultzmann or one of its modifications should be used 
for this purpose, with one of the following solutions: 



GLEET. 267 

Bichloride of Mercury, 1-10000. 

Carbolic Acid, 1-200. 

Nitrate of Silver, 1-5000. 

Potass. Permang., 1—5000. 

Dobell's Solution. 

Injections can be repeated daily for two weeks or 
until shreads disappear from the urine, then every 
second or third day, gradually discontinuing. If 
the solutions are well borne they should be increased 
in strength up to 1-2000 of the bichloride, 1-1500 
of the silver, and 1—1000 of the permanganate, and 
every third day a full-sized sound is to be passed. 
(W. M.) 

Thallin Sulphate: — This remedy in 15-20 per cent, 
solutions is preferred by some surgeons as the best 
astringent and antiseptic application for general use 
in the posterior urethra. Solutions of this strength 
are for direct application and not for injection or ir- 
rigation. They may be alternated with irrigations 
of nitrate of silver or permanganate of potassium. 
(B. H.) 

Instillations* are of especial service; the remedies 
which have been generally effective administered in 
this manner are the following: 

Stimulating Applications are indicated when the 
endoscope reveals the presence of localized areas of 
hyperemia, erosions, inflammation and infiltration 
of the follicles. The following remedies of this nature 
are for use by direct application through the urethro- 
scope : 

Hamamelis: — The pure fluid extract is said to 

Note. — For method of application of Irrigation and Instillation 
see Gonorrhoea. 



268 DIGEST OF EXTERNAL THERAPEUTICS. 

constitute one of the best local remedial agents when 
applied with a cotton wrapped probe through the 
endoscope. This will never be found too strong ap- 
plied in this manner, whereas the same remedy used 
as a 25 per cent, injection will cause pain and incon- 
venience. (B. H.) 

Nitrate of Silver: — Solution of grs. x— 3 is the best 
application in superficial catarrh and inflammation 
of the urethral follicles in the earlier stages. 

Iodine, 4 Carbolic Acid and Lugol's Solution, equal 
parts; same indications as nitrate of silver. Mer- 
curic Bichloride, 1—100. Carbolic Acid, 10 per cent, 
in alcohol. 

Astringent Injections, such as Alum, Zinc Sulphate 
and Carbolic Acid, are of service after the use of the 
endoscope for the bleeding and ardor urinae. (W. M.) 

Passage of the Cold Steel Sound: — This will act 
favorably in a large proportion of cases in dispersing 
granulations and infiltration and emptying pus dis- 
tended follicles, and generally tone up the mucous 
membrane. (B. H.) 

Rectal Douches: — When there is irritability of the 
bladder or sexual neuroses, copious rectal douches 
may be employed with benefit. (W. M.) 

Iodine and Glycerine: — From 3-10 grains of the 
former to 1 ounce of the latter, is used for painting 
the urethra through the endoscope ; stronger solu- 
tions must be used with caution. (B. H.) 

Excellent results are claimed for the following com- 
binations, which are introduced through the endo- 
scopic tube : 

Iodoform., 31 v. 

Tr. Benzoin Comp., 

Bals. Peruv., aa 5i. 



clossitis. 269 

Or, 

Iodi Resublimat. , grs. xx. 

Eucalyptol., grs. ii. 

Potass. Iodid., grs. ii. 

'Acid. Carbolici, gr. ss. 

Boroglycerid., q. s. ad. ^ii. (B. H.) 

Ointments: — Remedies applied in this way are often 
beneficial. The ointment is smeared upon the warm 
sound, which is allowed to cool before introduction, 
thus causing it to adhere, viz : 

Ichthyoli, grs. xlviii. 

Lanolini, ^i. 

Or, 

Argent. Nit., grs. v. 

Bal. Peruv., grs. x. 

Cerse Flav., grs. x, 

01. Theobromi, %i. 
Melt over water bath. 

Or, 

Creolin, grs. v-xv. 

Lanolini, ^ i. 

01. Olivse, 3ss. W. M.) 

Or. 

Potass. Iodid., 3ss. 

Iodi, grs. v. 

Ol. Olivse, ^i. 

Lanolini, !§i. (W. M.) 

Strictures, which are often the cause of chronic ure- 
thral discharges, should receive appropriate surgical 
treatment. 



GLOSSITIS. 

Superficial: — Cleanliness is most important, and all 
local causes of irritation, such as bad teeth and ill- 
fitting false teeth, should be removed. (Gn.) 



270 DIGEST OF EXTERNAL THERAPEUTICS. 

Ice will prove grateful and assist in allaying in- 
flammation. (Gn.) 

Bismuth. Subnit.: — 5 grains to rose water 1 ounce, 
is useful and agreeable, or with the addition of a 
little glycerine. 

Mouth Washes containing Boric Acid, Hydrastis, 
Thymol, etc., are beneficial. (See Aphthae.) 

Parenchymatous. — This form requires more active 
treatment. 

Deep Scarification indicated if the tongue becomes 
alarmingly oedematous. (An.) 

Leeches applied between the hyoid arch and the 
angle of the jaw, with scarification, are of great ser- 
vice in relieving swelling. (An.) 

Steam Atomization: — Medicated vapors, such as 
those of Ammonium Chloride or Compound Tinc- 
ture of Benzoin, favor resolution. (An.) 

Incision: — This maybe demanded even before the 
advent of suppuration ; the incisions should be made 
on the superior surface of the tongue on either side of 
the median line. (Gn. ) When incision is followed by 
vapor of hot water great relief is obtained. 

Tracheotomy: — May be required if incision does 
not relieve, though it is rarely called for. (An.) 

(For treatment of Glossitis Dessicans and Fissures, 
see Fissure of the Tongue.) 

GLOTTIS, OEDEMA OF. 

(See (Edematous Laryngitis.) 

GOITRE— BRONCHOCELE. 

Iodine: — The tincture has been used with better re- 
sults in the cystic than in the fibrous variety, 8—10 
drops may be thrown into the substance of the tu- 



GOITRE — BRONCHOCELE. 271 

mor in different parts every three to five days. 
Marked elevation of temperature accompanied by 
pain and stiffness of neck are indications for suspend- 
ing treatment. (Agnew.) Gosselin's use of iodine in 
treating cystic goitre consists of incising the skin 
over the gland and introducing a small trocar and 
evacuating the contents of the cyst, then cleansing 
the cavity with sterilized water and injecting 1 
drachm of tr. iodine ; this is permitted to remain in 
five minutes ; should its discharge be followed by 
blood a second injection is made. (Pp.) Injections 
of 10—15 drops, repeated every two or three days 
until ten injections have been given (L. T.), or 20—30 
minims of a solution of 1—12 of alcohol injected twice 
a week, a new point being selected each time, care 
being observed not to wound any vessel, are other 
methods of applicaiton. 

Iodoform: — Also employed in several ways ; Mose- 
tig advised as a substitute for iodine the following : 
Iodoform, 1 part; ether, 5 parts; olive oil, 9, or in 
the proportion of 1, 7, 7. (Garre.) This is free from 
danger. (L. T.) It is also used hypodermically with 
good results in solution or sterile emulsion, and a 10 
per cent, solution being employed, and from two to 
three drops injected in the base of the growth (F.); as 
an ointment, giss, with benzoated lard ^i, rubbed in for 
fifteen or twenty minutes, night and morning; a piece 
of lint smeared with the same is then laid on and 
covered with oiled silk. (Pp.) 

Red Iodide of Mercury: — A piece of the ointment 
the size of a pea is rubbed over the surface of the 
goitre until sensitiveness is produced ; in a few days 
this procedure is repeated, and continued with neces- 
sary intermission for weeks and even months. The 



272 DIGEST OF EXTERNAL THERAPEUTICS. 

rays of the sun are said to help the action. (L. T.) 
Another method of application is to employ an oint- 
ment of the strength of 15 grains of the mercury to 
1 ounce of ointment base. A small portion of this is 
rubbed over the goitre, which is then exposed to the 
rays of the sun as long as the patient can bear it. 
Within half an hour a smarting sensation is felt, and 
at the end of an hour a blister will appear which 
should be treated in the usual manner. The effect of 
the drug continues long after the blister has healed, 
and the tumor is said to decrease. (Al.) 

Yellow Iodide of Mercury, 3i, Oleic Acid, ^ix, rec- 
ommended by Lefferts for fibrous variety. 

Perchloride of Iron: — Was used by Mackenzie in 
place of iodine in cystic goitre ; 1 part to 4 of water, 
injection of 1—2 drachms, according to the plan of 
Gosselin ; the injection is allowed to remain in three 
days ; if the discharge is bloody it is repeated, if pur- 
ulent the canula is allowed to remain for drainage. 
During this treatment the neck is covered by flaxseed 
poultices. (Pp.) 

Ergot: — Preferable to iodine in the vascular varie- 
ties ; 10-20 drops of the fluid extract hypodermically 
have been employed. (Pp.) 

Electrolysis: — Effective to a certain extent, the first 
applications being followed by a decrease in the size 
of the tumor, which is less and less marked after sub- 
sequent applications. Large needles, insulated to 
within a short distance of the points, are introduced 
into the substance of the gland ; these are attached to 
the negative pole ; the positive pole is attached to a 
large flat electrode which is applied over the gland a 
short distance from the needle. A current of from 
5-10 milliamperes may be applied for five minutes. 
(Gn.) 



GOITRE, EXOPHTHALMIC. 273 

Stronger currents have been advised (Dickson), be- 
ing regarded as useful in the earlier stages of the dis- 
ease. A current of 100—150 milliamperes is applied 
for ten minutes at a time, a clay electrode being 
placed over the goitre and a large wire gauze elec- 
trode between the shoulders. When puncture of the 
growth is made, a current of 50 milliamperes is ap- 
plied for eight minutes. Another method consists of 
aspiration of the cyst, followed by injection of a hot 
solution of sodium chloride, ^i— gii, followed by appli- 
cations through the canula of a current of 50-100 
milliamperes for ten minutes ; the salt solution is then 
withdrawn. Rockwell objects to these strong cur- 
rents. (Sj.) 

Extirpation: — When all other means have failed, and 
the growth is large and causes dangerous symptoms, 
this procedure must be considered. Better results 
are obtained from operative treatment than from 
medical, but the high rate of mortality contra-indi- 
cates its use until after all other measures have 
proved unavailing. (L. T.) (See paragraph on ex- 
tirpation under Exophthalmic Goitre.) 



GOITRE, EXOPHTHALMIC. 

Leiter's Coil: — Applied over the lower part of the 
neck and upper part of the sternum is more successful 
than any other treatment, according to Osier. It re- 
lieves the rapid heart action. 

Ung. Hydrarg. Oxid. Rubr.: — Employed as de- 
scribed in simple goitre or bronchocele has also been 
used for this affection. (L. T.) 

Electricity: — Galvanism, 25-75 milliamperes, is 

19 



274 DIGEST OF EXTERNAL THERAPEUTICS. 

recommended hj Rockwell, using sculptor's clay for 
electrode ; the positive pole is placed over the sixth 
cervical vertebra and the negative over the region of 
the solar plexus ; the positive pole is shifted to the 
goitre during the seance ; the duration of application 
is from two to five minutes. (L. T.) 

Faradism, positive pole on the neck over the caro- 
tid artery at the level of the angle of the jaw and the 
border of the sterno-cleido-mastoid muscle, on each 
side ; the negative to the orbicularis palpebrarum 
muscle, thyroid gland and prascordium near the ster- 
num at the line of the third intercostal space ; appli- 
cation being made to these localities in succession. 
(L.T.) 

The seance should occupy about six to twelve 
minutes, and the course of treatment continued from 
six to twelve months. Electrical treatment, accord- 
ing to Osier, should be tried for more than three or 
four months. 

Hydrotherapeutics: — Act favorably in some cases ; 
packing, needle baths, and sea baths (Pp.) combined 
with galvanism and message, have had good effect. 
Cold sponge baths, tepid baths, hip baths. (An.) 
Mustard to the feet with cold to the thyroid gland 
are also methods which are worthy of consideration. 
(Gn.) 

Removal of Nasal Hypertrophies have cured a few 
cases. (Gn.) 

Change of Climate and Moderate Elevation have 
beneficial effects in cases not too far advanced. (An.) 

Rest and freedom from excitement are essentials to 
successful treatment. (Ty.) 

Extirpation: — Though statistics show somewhat 
varying results, they warrant the opinion that if 



GONORRHOEA. 275 

medical treatment has failed and the symptoms are 
urgent an operation should be performed. It should 
be borne in mind that the entire extirpation of the 
gland is liable to be followed by myxoedema. (An.) 
Ligation of the Thyroid Arteries: — This procedure 
has been employed in some cases; its preference to ex- 
tirpation is a matter to be decided by the operator 
according to the indications of each case. (An.) 



GONORRHOEA. 

Abortive treatment is generally condemned by 
manv recent writers as productive of more harm than 
good. (CI.) 

Injections: — As a rule injections should not be ad- 
vised during the advancing stage, as long as internal 
remedies appear to be acting satisfactorily; weak so- 
lution of bichloride of mercury, however, as men- 
tioned in the succeeding paragraphs, may be em- 
ployed with good effect. In the use of injections care 
should be observed not to exert force or to overdis- 
tend the urethra, nor to send the fluid beyond the 
first few inches of the pendulous portion; they should 
not, moreover, be of sufficient strength to cause pain 
or an uncomfortable sensation of fulness when used 
for the first time. Injections may be administered 
three or four times a day and always after urinating. 
(Cl.) 

The selection of the syringe is a matter of import- 
ance; it should be conical-pointed and known as "ex- 
celsior P," according to Dr. Lydston. 

Hydrarg. Bichlorid: — During the advancing stage, 
injections, if made at all, should be very mild. 



276 DIGEST OF EXTERNAL THERAPEUTICS. 

A weak solution of 1-20,000-40,000 may be 
used as a douche with Kiefer's two-ways tube at- 
tached to a fountain syringe; 1-2 quarts may be thus 
administered. (CI.) These weak solutions form 
about the best injections for this period of the dis- 
ease. (B. H.) 

Solutions of 1-20,000 or 30,000 may be used by in- 
jection with good effect in the secondary stage of se- 
vere acute urethritis; inject about 2 drachms. Strong 
solutions are of doubtful efficacy and may cause in- 
tense pain and increase inflammation. (CI.) 

If severe smarting on urination follows, in a day or 
two, the use of the bichloride, the solution must be 
weakened or discontinued. 

In place of the sublimate during the increasing 
stage, the following anodyne injection may be given: 

Atropin. Sulph., grs. ii. 

Bismuth. Subnit., ^iv. 

Mucil. Acaciae, 

Aq. Destill., aa ^ii. 

Shake well and inject three times a day. 

Morphias Sulph., grs. viii. 

Cocainae, grs. iv. 

Mucil. Acacias, ^i. 

Aq. Destill., q. s. ad. gii. (B. H.) 

If mild and sedative astringents in combination 
with anodynes are desired, the following will be 
found useful formulas : 

Plumbi Acetat. , grs. iv. 

Vini Opii, ^ii. 

Aq. Rosas, q. s. ad. ^iv. 
Inject three times a day. 

Or, 

Sod. Biborat, grs. xx. 

Morphias Sulph., grs. vi. 

Aq. Rosas, ^iv. 
Inject three times a day. (B. H.) 



GONORRHOEA. 277 

For a purely sedative effect : 

Acid. Borici, 3 ii. 

Aq. Ext. Opii, grs. xv. 

Liq. Plumbi Subacetat., Dil., %vi. (CI.) 

Hydrogen Peroxide, solution of 1—4 and Potass. 
Permang., 1-4000, are useful injections for the first 
stage. (F.) 

Pyrogen: — 1 per cent, solution can also be used to 
advantage. (CI.) 

Ichthyol: — 1-2 per cent, solution as an irrigation 
is claimed to be indicated in preference to any other 
remedy. It may be used in the beginning of the at- 
tack, two irrigations daily for five or six days, but if 
it is not well borne and there is no modification of 
the discharge suspend until the subacute stage is 
reached. In the period of decline 1—2 per cent, solu- 
tions will generally lead to a rapid cure. The remedy 
thus employed is painless. (T. 97.) 

Zinc: — In the stationary stage of the disease as- 
tringent injections in stronger solutions are indi- 
cated. The most popular and one of the best is zinc 
sulphate, though the sulph. carbolate or the iodide 
are preferred by some. 

The following are recommended : 





Zinc. Sulphat., vel. 


Acetat. , 




grs. xii. 




Morphias Sulph., 






grs. x. 




Glycerini, 






Ii. 




Aq. Rosae, 






§iii. 


Or, 


Zinc. Iodid., 
Acid. Carbolici, 
Aq. Destill., 

Plumbi Acetatis, 
Tr. Opii, 






grs. viii. 
grs. iv. 
giv. 

grs. xx. 
3ii- 




Aq. Rosae, 




q. s. ad 


. 3«r. (B. H.) 



278 DIGEST OF EXTERNAL THERAPEUTICS. 

Zinc. Sulpho Carbolat., grs. ii-v. 

Aq. Rosae, Ji. (CI.) 

Hydrastis: — One of the most effective of the vegeta- 
ble astringents, the muriate of the alkaloid being 
popular. 

The following formulas are efficacious : 

Aq. Ext. Hydrastis (Ernesty), 3 i— ii. 

Zinc. Sulphat., grs. i-ii. 

Aquae, % ii. (CI. ) 

Hydrastin Mur., grs. x. 

Ext. Hamamelidis, Fid., £ii. 

Glycerini, 31. 

Aq. Destill., q. s. ad. gvi. (B. H. ) 

"Injection Brou " — Well known among the laity, 
according to Bumstead,is as follows: 



Zinc. Sulphat., 


grs. xv. 


Plumbi Acetat., 


grs. xxx 


Fid. Ext. Krameriae, 




Tr. Opii, 


aa sjiii. 


Aquae, 


ad. ^vi. 


rd recommended the followin 


g'- 


Zinc. Sulphat., 




Acid. Tannici, 


aa grs. xv. 


Aq. Rosae, 


^ vi. 



(F-> 



Inject half an ounce two or three times daily. 

In the stage of decline the strength of the injections 
may be increased sometimes to double the propor- 
tions given. This must be done carefully, and in no 
instance should any be administered which produces 
considerable pain. A slight smarting only is to be 
expected. If any injection is found to cause increased 
pain or burning on micturition it should be weakened 
or discontinued. (B. H.) 

Gallobromal: — 1—2 per cent, solution, said to be 



GONORRHOEA. 279 

especially efficient as an injection for the relief of 
chordee. (F.) 

Pyoktanin: — Solutions of 1—1000 are effective in 
killing gonococci. (B.) Solutions of 1-1000-2000 
retained one minute, in 68 cases, were painless, in 3 
were intensely painful. (Sj . ) 

Creosote: — Injections of 2—10 per mille of an emul- 
sion were used in 58 acute cases with good results. 
It seems to have an anaesthetic effect. (T. 97.) 

Sulphate of Thallin: — Solution of 20 grains with 
rose water, 1 ounce, often useful. (B. H.) 

Nitrate of Silver: — Frequently of great service. 
Treatment with this remedy by injections of solution 
of 1—4000 (gr. i— 3ix), never stronger than 1—2000, 
was recommended by Friedheim and Neilson to be in- 
stituted early. The immediate effect is to increase 
the discharge, which in the course of four days be- 
comes thinner, whiter and less abundant. After a 
fair trial of the above solutions, if the discharge con- 
tinues, the strength of the injection may be increased 
to gr. i— ^iv, or it may be changed to sulphate of zinc 
or some other astringent. According to Neisser, ni- 
trate of silver stands at the head of the list of reme- 
dies for gonorrhoea, and bichloride of mercury sec- 
ond. ( Al. ) Carleton recommends the remedy for the 
secondary stage. 

When in the stage of decline, examination of the 
urethra with the Otis urethrometer or bulbous bougie 
gives evidence of small areas of granulation or ure- 
thral inflammation, one or two drops of a solution 
of the strength of *4 gr.-60 per ounce, but usually 
4—10 grs. per ounce may be applied every third day 
with good results, using for the purpose the Key's- 
Ultzmann syringe. The best results are said to be 



280 DIGEST OF EXTERNAL THERAPEUTICS. 

those obtained by commencing with the weakest solu- 
tion and increasing the strength as indicated, using 
an instrument devised by R. W. Taylor. About 30 
drops of a 1-2000 solution are taken up in an ounce 
glass syringe with the nozzle drawn to a sharp point, 
a No. 8 French gum catheter is cut to the length of 
8Y2 inches and introduced to the point desired with 
the patient standing. The proper amount of the so- 
lution is now injected, the catheter withdrawn and a 
piece of absorbent cotton applied to the meatus, 
which may be retained by an elastic band or the 
foreskin to protect the linen. (CI.) 

Solutions of nitrate of silver, grs. iv— xl— gi, applied 
by means of a pledget of cotton on an aluminum 
probe through the endoscope are indicated when the 
granulations are large and numerous, but should not 
be used more frequently than once in four to eight 
days. (CI.) 

Protargol: — This chemical combination of silver 
and albumen has been used with gratifying results. 
It is soluble in both hot and cold water, and may be 
administered by urethral injection in solution of V2 to 
1 percent. The weaker solution should be used first, 
and the strength gradually increased to the stronger. 
About tWo drachms maybe injected and retained for 
two minutes. 

These solutions can be administered as soon as the 
gonococci are found in the discharge ; they do not in- 
jure the mucous membrane, but act rapidly in de- 
stroying the gonococci. After the disappearance of 
the latter, astringent injections, such as zinc sulphate, 
may be substituted. The remedy apparently acts as 
a proplrylactic after exposure to gonorrhoea. (M. T., 
11, 98.) 



GONORRHOEA- 281 

Argonin: — A combination of silver and casein; is 
very similar to protargol ; it is used in 8 per cent, so- 
lutions. Its action is also satisfactory, though great 
care should be observed in its preparation, for un- 
pleasant results will follow an improperly prepared 
article. (M. T., 11, 98.) 

Argentamine: — For anterior urethral injection so- 
lutions of 1-4000-5000, and of 1-2000-4000 are rec- 
ommended. For deep urethral injection 15—30 
minims of a solution of 1—500-1000. This remedy, 
it is claimed, is suited to any stage ; it penetrates 
more deeply than nitrate of silver, which produces, 
with albumen and sodium chloride, insoluble com- 
pounds. The secretion is increased at first, then de- 
creases rapidly. Treatment should continue for 
about two weeks. (Sj.) 

Retrojection: — This is more effective than simple in- 
jection, but has the disadvantage of requiring assist- 
ance for the application of its technique. The patient 
should sit on the edge of a chair over a basin, then 
an ordinary woven catheter, well lubricated, is in- 
serted to the depth of about five inches; to the cathe- 
ter a rubber tubing, 4 or 5 feet long, is attached, 
which is connected with a fountain syringe or irri- 
gator of 1—2 quarts capacity ; the irrigator is then 
elevated two or three feet until the solution runs 
in and forces its way out at the meatus alongside 
the catheter; the urethra is thus washed out with the 
entire contents of the irrigator. The same solutions 
may be used as those employed for injections, but, as 
a rule, they should be somewhat weaker. (F.) 

This method is regarded by some writers as not 
only of difficult application, but of questionable util- 
ity, except in cases which have a tendency to become 
chronic. 



282 DIGEST OF EXTERNAL THERAPEUTICS. 

Irrigation: — This procedure, which has already 
been frequently mentioned, is especially indicated 
when the posterior urethra is involved. The most 
effective method of application is that of Ultzmann, 
which consists of the introduction just beyond the 
compressor urethrae muscle of a short silver catheter 
with four longitudinal slits instead of the usual eye ; 
a hard rubber syringe of 3—4 ounces capacity is 
filled with the selected solution and attached by 
means of a soft rubber tubing, then the fluid is gently 
injected into the membranous urethra, when, over- 
coming the internal sphincter, it will flow into the 
bladder; this repeated until the bladder is filled. 
When the patient desires, he is allowed to urinate 
through the urethra, the catheter being removed. Ir- 
rigations should be administered in the recumbent 
posture and the solutions should be well warmed. 
The same solutions may be used as for retrojection. 
A favorite method of Ultzmann was to begin with a 
solution of sulphate of zinc, alum and carbolic acid, 
each 1 part to 2000 of water ; on the next day this 
was increased to 1-1500, on the third 1—1000, on the 
fourth 1—500. If this was well tolerated the solution 
was changed to one of potassium permanganate, 1- 
2000, which was increased in strength in the same 
way up to 1—1000, when a solution of nitrate of sil- 
ver, 1-2000, was employed, which in turn was grad- 
ually increased up to 1—1000 ; in this way the ure- 
thra becomes accustomed to the solutions without 
inconvenience. When it is not desirable to pass a 
catheter, the bladder may be filled by hydrostatic 
pressure alone. (F.) 

Instillation: — This method is employed for the ap- 
plication of a small quantity of a strong solution to 



GONORRHOEA. 283 

the posterior portion of the urethra without the an- 
terior being affected. To accomplish this, use the 
drop syringe, which consists of a short silver cathe- 
ter with very thick walls and a capillary lumen, to its 
proximal end a hypodermic syringe is attached ; the 
desired amount of the solution is drawn up into the 
syringe, the catheter introduced until the end has 
passed the membranous portion of the urethra, 
which will be indicated when the long axis of the ca- 
theter is at 45° from the vertical, showing that the 
triangular ligament has been passed, and the injection 
then made. Strong injections may be administered 
in this way, nitrate of silver being most frequently 
employed in strengths ranging from 1—10 per cent. 
If properly applied none of the injection will return. 
(F.) 

GONORRHCBA IN THE FEMALE: 

The external parts should be bathed with solutions 
of Calendula or Borax, dried with absorbent cotton, 
and dusted with Bismuth Subnitrate or Oleate of 
Zinc. (CI.) 

Bichloride of Mercury: — Hot vaginal douches of a 
1—20,000 solution night and morning. (CI.) Stronger 
solutions, as 1—2000, are employed for swabbing out 
the parts. As soon as the more acute symptoms 
have subsided energetic treatment is indicated, and 
the following will be found effective : First cleanse 
the surface thoroughly with soap and water, and a 
sponge upon a holder to reach the vaginal inequali- 
ties, cocaine being used if necessary; introduce a Fer- 
guson speculum and paint the entire surface with a 
solution of the bichloride, 1—1000, beginning at the 
cervix; then wash with warm water, reintroduce the 
speculum and insert sterilized gauze of three or four 



284 DIGEST OF EXTERNAL THERAPEUTICS. 

thicknesses to keep the vaginal walls apart and per- 
mit of free drainage. This treatment should be re- 
peated daily. (K. C.) 

For the urethritis, which occurs as a complication, 
first inject a 4 per cent, solution of cocaine, then, 
while making a little pressure upon the vesical end of 
the urethra, introduce a small glass nozzle and irri- 
gate the canal with a solution of the bichloride of 1- 
20,000. This may be repeated every day if neces- 
sary. (K. C.) 

Formalin: — Has been strongly recommended by re- 
cent writers ; the vulva should be washed with a 1- 
1000 solution, and before using the speculum wash 
out the vagina with a 2-3 per cent, solution. Swab 
out the cervical canal with 1—500, and if the cervix is 
ulcerated apply a tampon saturated with 1-1000, 
(T. 98.) 

Lysol: — Free irrigation of a 1 per cent, solution is 
much used. (T. 96.) 

Tannin and Alum: — Equal parts, a tablespoonful 
of the mixture to one quart of water as a douche, 
forms, it is claimed, when combined with the proper 
hygienic and therapeutic measures, one of the most 
effective local remedies. In pregnant women the 
tannin should be reduced, making 1 part to 4-5 of 
alum. (F.) Powdered tannin or alum is useful for 
dusting on granulations after the third week. (CI.) 

Sodium Formate: — y 2 -l per cent, solutions are 
used. (T. 96.) 

Bismuth: — In vaginal capsules, is recommended 
when the passage of the speculum is prevented on ac- 
count of sensitiveness of the parts. When instrumen- 
tation is possible the daily application of tampons 
soaked in glycerine or boroglyceride with half a 
drachm of bismuth has good results. 



GONORRHOEA. 285 

Zinc Oleate: — Equal parts, with iodoform make 
an excellent insufflating powder when the surfaces 
are excoriated. The oleate should be made with Cas- 
tile soap. (Sw.) 

Nitrate of Silver: — Solutions of 2— 40 grains to the 
ounce are effective after the third week for the 
granulations remaining in the vagina or cul-de- 
sac. (CI.) Strong solutions, such as 20 grains to 
the ounce, are used for inveterate cases, and may 
be employed in the following manner: Pour the 
solution into a hollow dish, introduce a Sims spec- 
ulum, and with a cotton swab on a stick apply 
the solution over the whole surface of the mu- 
cous membrane of the vagina, cervix and vulva ; the 
pain is only temporary, but cocaine may be first ap- 
plied ; as soon as the surface is dry, it should be 
anointed with vaseline and a small tampon inserted. 
Douches should follow each fresh dressing. (Sw.) 
Stronger solutions are used, even up to the satur- 
ated. (K. C.) The same remedy is an excellent ap- 
plication for the persistence of the disease in the 
ducts and glands of Skene ; the finger is introduced 
into the vagina, and by pressing and drawing for- 
ward along the course of the urethra, a drop of pus 
will exude ; this condition may be removed by inject- 
ing with a hypodermic syringe solutions of 4—40 
grains to the ounce. (CI.) 

Picric Acid: — Solutions of 1-1000 are effective for 
treating the glands of Skene, and may be employed 
in the same way as nitrate of silver. (CI.) 

Iodine: — The tincture painted on the vaginal wall 
in the latter stage of the disease is useful when 
stimulation is indicated. (K. C.) 

Gallobromal: — 5 per cent, solutions for urethritis 



286 DIGEST OF EXTERNAL THERAPEUTICS. 

are recommended, injections being made into the 
bladder. The external parts may be swabbed with 
a 20 per cent, solution. (Sj.) 



GOUT. 

ACUTE GOUT: 

Local treatment is usually confined to wrapping 
the part in flannel or cotton batting and the applica- 
tion of alkaline solutions "and anodynes such as the 
following : 

Atropiae, grs. iii. 

Morph. Hydrochlorat., grs. xv. 

Acid. Oleici, j|i. 

Paint on the painful parts with a large camel's hair brush and 
cover with cotton and towel bandage. (H.) 

Or, 

Lin. Belladonnse, ^iii. 

Morph. Sulph., grs. x. 

Of this, use i tablespoonful to half an ounce of hot water and 
apply every two hours on lint, covering with oiled silk. (H.) 

Hot Mustard Foot Baths are of service and should 
be employed in retrocedent gout. (H.) 

The following has been reported as effective : 

Take half an oz. of Iodide of Potassium dissolved 
in a 8 ozs. of Rectified Spirit, add 1 ounce of 
Soap Liniment, then half a drachm each of Oil of 
Cloves and Oil of Cajuput; a cloth soaked in this 
mixture is wrapped around the affected part and 
covered with protective and bandaged. This acts 
as a powerful counter-irritant and the inflammation, 
it is claimed, is subdued in from twelve to twenty- 
four hours. The treatment appears to have been em- 
ployed in robust cases. (T. 98.) 



GUMBOIL. 287 

CHRONIC GOUT: (See Arthritis.) 

GUMBOIL. 

A roasted Fig applied as hot as can be borne to the 
inflamed gum will often afford relief. A small por- 
tion of Chamomile Flowers dipped in hot water and 
for convenience placed in a little lace bag, similarly 
applied, is also effective. When pus has formed it 
should be evacuated by free incision. No poultice 
should be placed on the face. 

GUMS, SPONGY AND ULCERATED 

Alum: — Excellent when the gums are spongy, with 
tendency to recede from the teeth ; it may be advan- 
tageously combined as follows : 

Alumin., gi. 

Tr. Cinchon., ^ss. 

Tr. Myrrh., ^ii. 

Mel. Rosae, 3jii. 

Vini, ' Oj. 

As a mouth wash. ( B.) 

Tannin: — Same indications as for alum; also useful 
in mercurial salivation, viz : 

Acid. Tannici, gi. 

Mel. Rosae, ^ii. 

Aquae, ^vi. 
As a mouth wash. (B. ) 

Tannate of glycerine applied with a brush also 
effective. (Sn.) 



288 DIGEST OF EXTERNAL THERAPEUTICS. 

Chromic Acid: — One of the best applications when 
gums tend to ulceration and retraction in scrofulous 
cases and after mercurial salivation. (N.) 

(See Stomatitis for further formulae, as many of 
the mouth washes under that head are also applica- 
ble to this condition.) 



H^EMATEMESIS. 

(See also Haemoptysis.) 

The application of a broad flat Ice Bag over the ep- 
igastrium, together with the subcutaneous adminis- 
tration of Ergotine, wall generally prove effective. 



HEMOPTYSIS. 

The patient should be placed in the recumbent pos- 
ture, with head and shoulders elevated. He must be 
kept absolutely quiet and not allowed to speak ex- 
cept when necessary. 

Ergot or Ergotine: — Subcutaneously administered 
is generally employed. (Gn.) 

Morphia: — One of the most effective remedies in dan- 
gerous cases ; it must be given hypodermically in full 
doses, 14 grain two or three times in twenty-four 
hours for an adult. (Gn.) 

Liq. Ferri Subsulphatis: — Sprays of a solution of 
51— gviii, caused to enter the throat with each inspira- 
tion, will often arrest, notwithstanding so little will 
pass the rima glottidis. (B.) 



HEMATURIA. 289 

Ice to the nape of the neck and chest (Rd.), also to 
the testicles or labia. (Sj.) 

Ether Spray to spine and chest. (Bt.) 



HEMATURIA. 

Local measures can only be of service when the 
bladder itself is the source of the bleeding in this 
case. Nitrate of Silver, y± gr.— gi, as a wash will 
prove valuable. (Al.) 



HEMORRHAGE. 

Local astringents and styptics: Alum, Agaric., 
Alcohol, Antipyrin., Creolin, 2-3 per cent, solution, 
especially adapted to haemorrhage from mucous 
membranes ; Ice, Oil of Turpentine for haemorrhage 
after removal of tonsils or extraction of teeth ; Styp- 
tic Cotton, Tannic Acid, Cold Water, Hot Water, 
Hamamelis, Monsol's Solution, and Tr. Ferri 
Chloridi. 

Actual Cautery: — Of inestimable value in arresting 
haemorrhage from vessels not possible to ligate. 

Ergot or Ergotine: — Subcutaneously, the fluid ex- 
tract of the former, or better the following solution 
of the latter : 

Ergotina;, grs. xxx. 

Glycerini (neutral), 

Aquae, aa ^ss. 

Dose, 15 minims. (T. 96.) 

Aq. Ammonia: — One or two drachms with an 

equal amount of water subcutaneously injected is 
20 



290 DIGEST OF EXTERNAL THERAPEUTICS. 

advised when thrombosis of a large venous trunk 
tends to form, as for example in the pulmonary ar- 
tery after uterine haemorrhage. (B.) 

Ether: — Subcutaneous injection of 1 drachm into 
the thigh as a stimulant. (B.) 

Intra-venous Saline Injections: — This is the prac- 
tice in England when life is threatened. The follow- 
ing is the formula of a powder which, added to a 
pint of water, constitutes a solution of the normal 
salinity of the blood : 

Sodii Chloridi, ■ grs, L. 

Potassii Chloridi, grs. iii. 

Sodii Sulphatis, grs. iiss. 

Sodii Phosphatis, grs. ii. 

Sodii Carbonatis, grs. iiss. 

The temperature varies with different operators ; 
some say it should be less than 100° F., and others 
prefer it hot as the hand can bear. (T. 96.) 

Artificial Serum, Subcutaneously: — Employed in 
desperate cases by subcutaneous injections of IV2 
parts into the thigh of the following : 
Sodii Phosphatis, 

Sodii Chloridi, aa 3 n - 

Aquae, Oij. (T. 96.) 

HEMORRHAGE FROM BONE : 

Yellow Wax: — A convenient way of arresting 
bleeding from cut ends of bones, after amputation, is 
by forcing a small bit of wax into the cancellated 
structure. (Al.) 

HEMORRHAGE FROM THE LARYNX : 

The following should be applied b3 r means of the 
laryngeal atomizer : 

Ferri Alumin. Sulph., grs. x-^i. 

Liq. Ferri Nusulphat, grs. x-^i. 

Acid Tannici, grs. xx-gi. 

Argent. Nitratis, grs. x-^1. (Bos.) 



• HEMORRHAGE. 291 

HEMORRHAGE POST-PARTUM : 

Immediately pass the hand into the uterus and 
turn out all clots or fragments of the placenta, clear- 
ing the cavity of its entire contents. Grasp the fun- 
dus with one hand, previously dipped into ice water; 
if this can be done without delay, hold the uterus 
firmly and press it down into one iliac fossa, and as 
quickly as possible inject a stream of water at a tem- 
perature of 110°— 120° F. If delay will be caused in 
obtaining hot water use cold, or pass into the uterus 
a piece of ice. While this is being done an attendant 
should raise the foot of the bed so that the hips will 
be elevated. After the haemorrhage has been suffi- 
ciently controlled, the lower extremities should be 
tied snugly, but not tight, with bands, and a com- 
press and binder applied over the uterus. (Ga., Ply.) 

Turpentine: — A piece of lint saturated with the 
remedy carried directly into the uterus, so as to be 
in contact with the inner surface, will act as a stimu- 
lant, produce contraction, and instantly check haem- 
orrhage. (T. 98. ) 

Tr. Iodine, Tr. Matico and Vinegar applied to the 
cavity of the uterus are effective for arresting haem- 
orrhage. (Ply.) 

The following method of applying Pressure was 
recommended by Playfair: Insert the fingers into the 
posterior cul-de-sac of the vagina and apply pressure; 
then with the other hand make counter pressure over 
the abdomen ; thus the anterior and posterior walls 
of the uterus are pressed together. (Ply.) 

If alarming symptoms persist, Compress the Ab- 
dominal Aorta, to the left of the spine, on a line with 
the umbilicus. (Ply.) 

Perchloride of Iron: — When everything else has 



292 DIGEST OF EXTERNAL THERAPEUTICS. 

failed, as a last resource inject a solution of iron into 
the uterine cavity, using liq. ferri perchlorid. 1-6 of 
water, or 2 drachms of the perchloride in a pint of 
water. (Ply.) 

Faradism: — If a batter\* should happen to be at 
hand, apply one pole to the uterine cavity and the 
other over the abdomen. This will produce contrac- 
tion. 

Subcutaneous injections of Ergot or Ergotine and 
Intravenous Saline Injections, as mentioned under 
the head of haemorrhage are, all indicated in this con- 
dition. 

HEMORRHAGE FROM THE RECTUM: 

The rectum should be examined by means of a spec- 
ulum, and the bleeding point ligated or cauterized 
Avith the Paquelin cautery. In case the point cannot 
be located, packing must be resorted to. Mr. Ailing- 
ham's method for this procedure is as f ollows : Take 
a cone-shaped sponge and pass a strong ligature 
through it near the apex ; it is then brought back so 
that the apex is held in the loop ; the sponge is now 
dampened, squeezed out, and dusted with an astrin- 
gent powder, preferably iron, introduced by the in- 
dex finger, apex first, and carried up five inches ; the 
ends of the ligatures should extend outside the anus ; 
the rectum below the sponge is now packed with cot- 
ton and dusted over with an astringent powder ; the 
ligatures are now seized and pulled down with one 
hand and pushed up with the other. Attention is 
called to the fact that when it becomes necessary to 
pack the rectum it should be done with great 
thoroughness, so that not a single point shall be ex- 
empt from pressure. (G't.) 

If it is intended to leave the packing in for some 



HEMORRHOIDS. 293 

time it is advisable to pass through the apex of the 
sponge a large stiff catheter so as to allow the escape 
of flatus and fluid fasces. (K.) 

Irrigation with very hot or cold astringent solu- 
tions are effective, such as Alum Water or infusion 
of Black Oak Bark; simple Hot Water with com- 
pression is also satisfactory. 

Local treatment for rectal haemorrhage may be 
summed up as consisting of ligation, cauterization, 
torsion, compression, styptics, astringents and hot 
and Cold Applications. (Gt.) 



HEMORRHOIDS. 

EXTERNAL : 

Treatment is seldom sought unless there is external 
inflammation. 

Hot Baths, frequent ablution of the part with Cas- 
tile soap and water, together with Rest in bed and 
the application of the Ice Bag, will prove grateful 
and effectual in most cases. 

Hot Fomentations may be used instead of the ice 
bag if the latter is not agreeable. 

Bathing the part should precede all remedial appli- 
cations. 

The following anodyne ointments and lotions will 
afford relief : 

Ext. Belladonnse and Ext.Opii: — The two extracts 
together or alone smeared over the part wall afford 
relief. (All.) 

Lead and Opium Wash: — Constantly applied hot 
or cold is very effective. (Gt.) 

Stramonium Ointment, alone or with equal parts 



294 DIGEST OF EXTERNAL THERAPEUTICS. 

of Gallic Acid Ointment, is one of the most service- 
able remedies. (Al.) 

Hamamelis: — The aqueous extract often used hot 
or cold according to the effect on the patient. A lit- 
tle may be injected into the rectum. 

After washing the parts, Mr. Allingham recom- 
mends one of the following: 

Bismuth. Subnit., 3 ii. 

Hydrarg. Subchlor., £i. 

Cocainae, grs. iv. 

Vaselini, J i, 



Or, 



Or, 



Bismuth., £ii. 

Cocainae, grs. vii. 

Vaselini, 5i. 



Liq. Plumbi Subacetat., dil. £i. 

Liq. Opii Ext., ^iv. 

Tr. Belladonnae, 3 ii. 

When the piles are down and difficult to replace or 
retain, Mr. Allingham recommends the following ap- 
plications spread on lint : 

Ung. Elemi, ^ss. 

Ung. Sambuci, ^ss. 

Bal. Copaibae, gi. 

Ext. Belladonnae, ^ss. 

Or, 

Ext. Belladonnae, 5i- 

Ext. Hyoscyami, 3 n - 

Ext. Conii 3"- 

Vaselini, %{. 

Nutgalls: — The ointment alone or with 1 drachm 
of powdered opium to the ounce. (Sm.) 

Nitrate of Silver: — Painting the piles daily with a 
2 per cent, solution is said to act very satisfactorily ; 
the application is painless. (T. 98.) 



HEMORRHOIDS. 295 

Iodoform: — Suppositories containing 5 grains each 
will sometimes have good effect. (Sm.) 

The following is recommended : Wash the part 
with a 2 per cent, solution of carbolic acid or 1 per 
cent, of creolin, dry with absorbent cotton and 
anoint with the following : 

Chrysarobini, grs. xii. 

Iodoformi grs. ivss. 

Ext. Belladonnae, grs. ix. 

Vaselini, 3 y i grs.xv.(Sn.) 

The pain will be relieved and the tumor will almost 
completely shrivel within three or four months. 
The following also prove useful: 

Cocainae Muriat., grs. xx. 

Morph. Sulph., grs. v. 

Atrop. Sulph., grs. iv. 

Pulv. Acid. Tannici, grs. xx. 

Vaselini, Ji. 

Ol. Rosae, q. s. 
Apyly after each evacuation of bowels. (Sn.) 

Or, 

Acid. Gallici, grs. x. 

Ext. Opii, 

Ext. Belladonnae, aa grs. iv, 

Ung. Simpicis, 3ss. 

Apply night and morning. (Sn. ) 

The following is indicated when the pile contains a 
hard clot: 



(Gt.) 



Morph. Sulph., 




grs. iii. 


Hydrarg. Chlor. 


Mitis, 


grs. xii 


Vaselini, 




Si- 


following is a 


useful cerate : 




Morph. Oleate (i 


:o per cent.), 


i part. 


Camphor, 




2 parts. 


Oil of Sassafras, 




4 parts. 


Resin, 




8 parts. 


Yellow Wax, 




1 6 parts. 


Benzoated Lard, 




24 parts. 



(H. F.) 



296 DIGEST OF EXTERNAL THERAPEUTICS. 

Apply on lint; melt the Wax, Resin and Lard together at a gentle 
heat, then digest the Camphor with the mixture until it is dis- 
solved, allow it to cool, and before it solidifies add the Morphine 
and Sassafras, and mix thoroughly. (H. F. ) 

Collodion: — Applied on fibres of cotton and spread 
over the pile after defecation. (T. 98.) 

/Esculus Hippocastinum: — Cerates or supposito- 
ries will often give good results. (Bt.) 

Collinsonia: — The cerate, especially when associated 
with uterine disorder. (Ga.) 

Boric Acid: — An ointment with vaseline has good 
effect in relieving the itching. (Ga.) 

After inflammation has subsided the haemorrhoids 
should be removed. 

INTERNAL : 

Hamamelis : — Employed satisfactorily in various 
ways, viz: Small injections of the watery extract, 
either hot or cold ; compresses, wet with the lotion, 
applied externally, or ointments or suppositories. 
(All.) 

Cold: — Some patients will derive benefit from the 
application of ice to the inflamed part ; small injec- 
tions of cold water will also be found suited to some 
cases. (K.) 

Heat: — May be used instead of cold in the same 
manner, hot fomentations and hot sitz baths espe- 
cially if there is strangulation of the pile. (F.) 

Suppositories of the following : 

Chrasarobini, grs. i|. 



Iodoform, gr. 



3_ 

1 



Ext. Belladonnae, gr. £. 

Ol. Theobromse, grs. xxx. (Sn.) 

If there is severe haemorrhage, tannin may be ad- 
ded. It is claimed that under the above treatment, 
which may be combined with the ointment of the 



HAEMORRHOIDS. 297 

same, when there are external haemorrhoids (see that 
subject) that pain and haemorrhage will disappear 
within three or four days and the tumors shrivel 
completely within three or four months. 
Or this : 



Cocainae Hydrochlor., 


grs. vii. 




Aq. Ext. Opii, 


grs. xx. 




Ext. Belladonnae, 


grs. xii. 




Ung. Populi, 


Si- 


(Sj.) 



Cutol: — 10 per cent, ointment. (Sj.) 

Hydrastis: — An important remedy used in the form 
of suppositories; it may be combined with good 
effect, each suppository to contain the following : 

Hydrastis, 3 grains. 

Hamamelis, 3 grains. 

Cocaine Hyderchl orate, \ grain. 

Coca Butter, q. s. (M. H.) 

Stramonium: — The ointment has a soothing effect 
and mav be combined with cocaine and hamamelis. 
(All.) 

Tannic Acid:— In various strengths in ointment 
and suppositories may be employed when there is 
much inflammation. (F.) 

Ferric Sulphate: — In the form of suppositories, 2 
grains each, when a strong astringent effect is de- 
sired. (F.) 

This sedative ointment is recommended by Shoe- 
maker : 

Ext. Opii, grs. x. 

Pulv. Stramonii, 5 1 - 

Pulv. Tabaci, 5 s8 - 

Ung. Simplicis, ^ss. (Sn.) 

Zinc. Subgallate: — As an antiseptic and dessicant, 



298 DIGEST OF EXTERNAL THERAPEUTICS. 

pure or diluted with an inert powder, or in the form 
of an ointment. (F.) 

Conium Ointment:— May be applied with benefit 
for the relief of pain. (M. W.) 

For small vascular tumors Mr. Allingham uses : 

Ferri Sulph., grs. x-xx. 

Cocainae, grs. viii. 

Vaselini, 5*- 



Or, 



Ferri Sulph., grs. ii. 

Theobromae, q. s. 



The Injection of Carbolic Acid has been highly 
commended and severely condemned. The latest 
writers are adverse to the procedure. 

For the methods of removal of haemorrhoids the 
reader is referred to works on surgery. 



HAY FEVER. 

(Compare Acute Rhinitis.) 

Cocaine Hydrochlorate: — One of the best pallia- 
tives for treatment of the exacerbations ; may be ap- 
plied in the form of a spray, by insufflation, or with a 
brush ; occasionally the relief obtained will last for 
the day, but more frequently it is transitory. For 
the spray a simple 4 per cent, solution may be em- 
ployed, which is the usual strength, but not infre- 
quently weaker solutions will act quite as well. 

The following are recommended by Bos worth : 



Cocainae Hydrochlor. , 


grs. x: 


Sodii Bicarb. , 




Acid. Boric, 


aa grs. x 


Aquae 


^. 



HAY FEVER. 299 



Cocainae Hydrochlor. , 




grs. x. 




Aquae, 




q. s. 




Ft. sol. et adde 








Cosmolini Fid., vel. 








Ol. Voschano, 




Si- 




Shake well before using, 








Insufflations of cocaine may 


be used according to 


the following : 








Cocainae Hydrochlor., 




grs. x. 




Bismuth. Subcarb., 




3i- 




Magnesiae Carb. Levis, 




3". 




Or, 








Morph. Tartrat., 




gr. i. 




Cocainae Hydrochlor., 




grs. x. 




Sulphuris Flor., 




3ss. 




Sac. Lac, 




3iiss. 


(Bos.) 


Menthol: — Preferred to cocaine 


by Ball; 5- 


-10 per 



cent, solutions in albolene or some other of the pe- 
troleum derivatives are employed with the atomizer. 

The same writer recommends the following : 

Rect. Spirits with 2 or 3 parts of water. 

Chromic Acid, gr. y 1 ^— -|— gi. 

Quin. Sulph., grs. ii-xi-gii. 

Sulphurous Acid and water, equal parts. 

Carbolic Acid, 1 part to 60. 

The following was advised by Sir Andrew Clark : 

Glycerine of Carbolic Acid, %i. 

Quinine Hydrochlorate, 3*- 

Mercury Perchloride, gr. I. 

Paint on the floor of the nose to naso-pharynx; two or three ap- 
plications will sometimes suffice to cure a paroxysm for the season, 
but the immediate effects are exceedingly irritating. ( Ba. ) 

Acetic Acid: — 2 per cent, solutions as nasal washes. 
(T.98.) 

Boric Acid and Salicylic Acid: — Equal parts as an 
insufflating powder. (Al.) 



300 DIGEST OF EXTERNAL THERAPEUTICS. 

Sodium Bisulphate:— Solutions of 1-5000 in water 
as a nasal wash. (T. 98.) 



HEADACHE. 

When congestive, Hot Foot Baths, Mustard Foot 
Baths or Mustard Sinapisms to the back of the neck 
are of service. (Wa.) 

Cold Water Effusions to the head or Ice Bag will 
sometimes relieve both the congestion and bilious 
sick headache; on the other hand Warm Applica- 
tions will suit some cases better. (R.) 

Morphine: — A hypodermic injection of a small dose 
acts frequently with excellent effect and is one of the 
most reliable remedies, at the same time one to be 
avoided until other means have been tried. (Ty.) 



HEART DISEASES, CHRONIC. 

The Schott Treatment: — This consists of exercises 
and carbonated brine baths, and is practiced with 
beneficial results at Nauheim, Germany. By the use 
of artificial baths the treatment can be carried out 
at home. The following is an outline of the home 
treatment : 

Synopsis of exercises. (Thn.) 

1. Movement of extended arms in three directions. 

(a) From ordinary position by the sides of the 
body forward and upward until they reach the tem- 
ples and back again. 

(b) From the same position, laterally outward and 
upward to the temples and back again. 



HEART DISEASES. 301 

(c) From the horizontal position with the palms of 
the hands meeting in front of the body as far apart 
as possible and back. Rotation of the extended arms 
about their axes as frilly as possible, causing prona- 
tion and supination. 

2. For the elbow, wrist and finger joints the nat- 
ural flexions and extensions; radial and ulnar abduc- 
tion and adduction. 

3. (a) Flexion of trunk forward from a little be- 
yond the erect position and back. 

(b) Lateral flexions of the trunk to the right, left 
and back. 

(c) Rotation of the trunk on its axis to right, left 
and back. 

4. Movements of each extended leg forward, up- 
ward, outward, upward, backward, upward and 
back. 

5. The natural flexions and extensions of the knee 
and ankle joints. 

Resistance is made by the attendant with the palm 
of the hand in the direction exactly opposite to the 
movement. In applying it to the wrist or ankles 
these parts should be placed in the fork formed by 
separating the thumb and index finger, and the limb 
should never be grasped lest support be given. The 
degree of resisting force should be as much as the 
patient can overcome without the slightest discom- 
fort, and it should be applied uniformly and evenly. 
The patient must be able to breathe quietty ; the 
mouth and alas nasi must be watched, and on the 
slightest indication of shortness of breath there 
should be a pause. Some of the movements may be 
omitted, according to circumstances ; the arms above 
the head and the trunk exercises are the most trying. 



302 DIGEST OF EXTERNAL THERAPEUTICS. 

The limbs must not be allowed to fall suddenly after 
the completion of a movement. The clothing should 
be loose and easy, and a considerable interval of time 
be allowed between the movements. This should be 
prolonged if there is fatigue. 

The exercises are usually given for about half an 
hour, the series being gone over twice in that time, 
but they are frequently employed for a shorter or 
longer period. A skilled attendant is, of course, 
necessary . ( Thn . ) 

Two new exercises, not resisted by the operator, 
have recently been suggested by Dr. T. E. Satter- 
thwaite, assisted by Dr. H. V. Barclay, which are de- 
scribed as follows : 

The patient lying on his back with the head a little 
elevated, the operator standing at his side passed his 
two arms under the chest and then raised it slowly 
and gently as far as possible without lifting the pa- 
tient off his bed. Then the chest was allowed to set- 
tle back into its normal position. This movement 
was of the nature of artificial respiration, and was 
useful in the cardiac degeneration of obese persons 
and in some cardiac cases, with respiratory embar- 
rassment owing to chronic pulmonary disease, for in 
some rare cases of chronic pulmonary disease with a 
cardiac complication, great relief and benefit might 
be obtained for the patient without danger, if such 
respiratory exercises were judiciously applied. 

Another of these respiratory series consisted in ele- 
vation of the shoulders. The patient sitting on a 
stool, and the operator on another stool behind him, 
grasped the axillae of the patient from in front ; he 
then lifted the patient's body upwards as far as it 
would go without leaving the stool, and then drew 



HEART DISEASES. 303 

the body over backwards, pressing his knee against 
the hollow of the patient's back. The boy was then 
allowed to settle down easily into the original posi- 
tion. (M. T., 4, 98.) 

The Artificial Nauheim Baths: — A scheme for a six 
weeks' course of baths would be about as follows : 

First Week. — V2 per cent, warm sea salt bath (2 lbs. 
to 50 gals.). Temperature 94—95 degrees F. Dura- 
tion 4 minutes. Intermission on third day. 

Second Week. — % per cent, warm salt bath (3 lbs. 
to 50 gals.). Temperature 93—94 degrees F. 6 min- 
utes. Intermission on fourth day ; V^ per cent, car- 
bonic acid gas. 

Third Week. — 1 per cent, warm rock salt bath (4 
lbs. to 50 gals.). Temperature 92—93 degrees. Carb. 
acid gas, V2 per cent., 8 minutes. Intermission every 
fourth day. 

Fourth Week. — l 1 /^ per cent, bath salt, warm (5 
lbs. to 50 gals.). Temperature 91-92 degrees F. 
Nauheim concen. brine salts, 8 oz., 10 minutes. Carb. 
acid gas, % per cent. Intermission fourth day. 

Fifth Week— 11/2 per cent, bath salts (7 lbs. to 50 
gals.). Temperature 90—91 degrees F. Nauheim con- 
centrated salts, 10 oz., 12 minutes. Carb. acid gas, 
% per cent. Intermission fifth day. 

Sixth Week.— 2 per cent, bath salt (10 lbs. to 50 
gals.). Temperature 80—88 degrees F. Nauheim 
concentrated salts, 12 oz. and carb. acid gas. 1 per 
cent. 14 minutes. Intermission every fifth day. 

It is stated in conclusion that the patient does not 
always feel better after a bath. There might be 
some precardial oppression, but this discomfort 
usually passed away at the end of a week. 

Baths and exercises each accomplished the same re- 



304 DIGEST OF EXTERNAL THERAPEUTICS. 

suit, but the most rapid and brilliant results were ob- 
tained when both were used together. But they 
were useful only up to a certain point ; after this has 
been reached they were harmful, and if at any time 
there was a tendency to relapse, the baths should be 
suspended. Generally, however, to be resumed again 
after a day or two. The final steps in the treatment 
consisted in two or three weeks of rest at some place 
of moderate elevation. In successful cases the im- 
provement was gradual and sometimes did not fully 
show itself until the patient had resumed his ordi- 
nary mode of life. The improvement might continue 
for many months, sometimes for more than a year. 
(M. T.,4, 98.) 

The contra-indication in the entire range of chronic 
cardio-vascular affections are advanced arterio-scler- 
osis, decided degeneration of the cardiac muscles and 
aneurism. (T. 98.) 



HEMIPLEGIA. 

(See Paralysis.) 

HERNIA, STRANGULATED. 

The patient should be placed on his back in bed, the 
foot of which should be elevated about twelve inches, 
the pelvis raised upon a pillow, the legs flexed upon 
the thighs and thighs upon the abdomen, or the knee 
and shoulder position may be assumed. (W.) 

Hot Applications: — Hot baths should be tried or 
towels dipped in hot water partly wrung out and 



HERNIA, STRANGULATED. 305 

laid on the tumor, and constantly renewed, will 
sometimes assist in relieving. (W.) 

Ice: — A bag filled with ice is also employed. (F.) 

Opium narcosis should be secured at once to relieve 
the pain and relax the parts. Morphia, subcuta- 
neously, or opium suppositories may be adminis- 
tered. " (W.) 

Ammon. Chlorid.: — In the absence of ice dissolve 5 
parts of the ammonia with 5 parts of nitrate of 
potash in 16 parts of water ; the temperature of the 
combined solution will fall from 50 to 10 F. This 
is placed in a bladder and applied to hernial tumors 
to promote reduction. (Al.) 

Chloroform Inhalation to assist in reduction has 
superseded the use of tobacco and lobelia. (P.) 

Lobelia: — The infusion may be given by enema 
with good effect. (F.) 

Tobacco: — Enema of the smoke or one containing 
not more than 15 grains has proved of great value, 
but lobelia is generally to be preferred. (F.) 

Taxis: — If applications do not succeed in an hour 
or two reduction should be attempted. All efforts in 
that direction should be gentle ; a trial should first 
be made without anaesthesia, then if unsuccessful, 
with an anaesthetic. (Ger.) The neck of the tumor 
should be grasped between the thumb and finger of 
one hand and the contents gently pushed into the 
canal with the other. Taxis should not be continued 
more than five or ten minutes at a time ; it may be 
repeated at intervals of half an hour during the first 
six hours of the strangulation, after that it is of 
doubtful utility, if not harmful, and after twelve 
hours should not be attempted. (W.) 

Operation: — When strangulation is not reduced 

21 



306 DIGEST OF EXTERNAL THERAPEUTICS. 

herniotomy should be performed within six hours 
after the accident, and should never be delayed more 
than twelve hours. Better results, says Wyeth, are 
obtained if the operation is performed during the 
earlier period. 



HERPES LABIALIS. 

(See Herpes Simplex.) 

HERPES CIRCINATUS. 

(See Trichophytosis Corporis.) 

HERPES PROGENITALIS. 

Usually little treatment will be required. Cleanse 
the parts, apply an antiseptic lotion, then dry and 
dust on a mild powder, such as equal parts of bis- 
muth subnitrate and zinc oleate (CI.), or apply a 
piece of lint soaked in Lead Water or Black Wash. 
(Vn.) 

Calomel: — Pure or with equal parts of Zinc oxide 
sprinkled on night and morning is useful when stim- 
ulation is required. (Vn.) 

Aristol or Airol: — Useful for abrasions. Astringent 
lotions are indicated if there is a tendency to recur- 
rence. 

Cold Douches to the lumbar region for half a 
minute twice a week, extra cleanliness, and the ap- 
plication of a little Alcohol on the first indication of 



HERPES SIMPLEX. 307 

the appearance of the eruption constitutes effective 
preventive treatment. (CI.) 



HERPES SIMPLEX. 

Treatment is yqtj simple, consisting of soothing 
and emollient applications; if on the lip a little Cold 
Cream or Oleate of Bismuth Ointment (see McCall 
Anderson's ointment under Acute Eczema). Care 
should be observed not to detach the crusts too soon. 

In extensive cases of herpes of the face apply Bread 
and Milk Poultice, Dilute Lead Water or Boric Acid 
in the powder, and when there are crusts some mild 
ointment. (Vn.) 

Camphor: — Will often abort the vesicles, and may 
be applied in the form of spirits or equal parts of the 
powder with borax. (B. H.) 

Flexible Collodion : — Very useful, especially for the 
lips. (F.) 

Ichthyol: — 1 per cent, solution, or an ointment of 
Zinc. Ichthyolate, 1 per cent. (B. H.) 

The following antiseptic lotions are recommended : 

Resorcin, 2 per cent.; Thymol, 3 per cent.; Men- 
thol, 2 per cent.; Tannin, 2 per cent., applied fre- 
quently. 



HERPES ZOSTER. 

It is important to prevent rupture of the vesicles, 
which leads to ulceration. To attain this end avoid 
ointments and apply bland astringent powders, 
such as Bismuth, Zinc Oxide or Starch, or paint the 



308 DIGEST OF EXTERNAL THERAPEUTICS. 

part with Flexible Collodion, combined with mor- 
phine (grs. x— gi), or alone. A soft linen bandage 
should complete the dressing. (Pp.) 
A useful dusting powder is as follows : 

Morphise Sulph., gr. ii. 

fulv. Amyli, 

Zinc. Oxidi, aa gss. (Vn.) 

Electricity: — The constant current, according to 
Duhring, will relieve if it does not abort. (B. H.) 
The sponge electrode is placed along the course of the 
nerves, and directly to the seat of the eruption, five 
to ten cells may be used, and the application should 
be made for fifteen minutes twice daily. (Vn.) 

The following lotions will prove useful: Lead 
Water, Lead and Opium Wash, Fid. Ext. Grindelia, 
3ss— Oj, or Zinc Carbonate Precipitate, Powdered 
Starch and Glycerine, each gss with water Oss. (Vn.) 

The following forms an effective lotion for the re- 
lief of pain ; it should be applied with wadding pads, 
frequently renewed : 

Alcohol, ^i. 

Menthol, grs. xv. 

Ext. Cannabis Indie, grs. xxv. (T. 98.) 

Cerates of Calendula, Camphor, Veratrine, half 
strength, and Zinc Oxide Ointment are indicated. 
(Bt.) 

Cerate of Cocaine: — May be used with some cau- 
tion, according to the extent of exposed surface in- 
volved. (M. W.) 

Ext. Belladonna or Ext. Opium: — An ointment of 
either, in the strength of 20 grains to the ounce, may 
be rubbed on when the eruption occurs on the scalp. 
(Vn.) 



HICCOUGH. 309 



HICCOUGH. 

Whiskey, Vinegar, Hot Brandy, or Mustard Plas- 
ters over the epigastrium frequently act very speed- 
ily. 

Blisters to epigastrium. 

Cold Shower, for the physiological effect of shock 
on the pneumo-gastric nerve. 

Ice or Leeches to epigastrium, especially in inflam- 
matory forms. (T. 96.) 

Deep Inspirations and holding the breath as long 
as possible is effective in mild cases. (Ta.) 

The following measures have been reported by Sa- 
jous as having been successfully employed in obsti- 
nate cases. 

Dry Cups over the abdomen ; energetic Pressure of 
the soft part of the patient's thumb against the lit- 
tle finger of the same hand ; Morphia and Atropia, 
subcutaneously, in sufficient doses to induce sleep; 
pungent snuff or other Sternutories to produce hard 
sneezing have succeeded after failure of other means ; 
Apomorphia, subcutaneously, to produce emesis has 
been followed by relief; Massage; Nitrite of Amyl 
inhalations. (Sj.) 

Pilocarpine: — Has succeeded when all other reme- 
dies have failed, in doses of T ^ grain three times a 
day subcutaneously. It appears best suited to cases 
of nervous origin. (T. 96.) 

Hard Pressure over epigastrium, a firm bandage 
or belt. (Bt.) 

The various forms of Electricity should be tried in 
intractable cases. (T. 96.) 



310 DIGEST OF EXTERNAL THERAPEUTICS. 



HIRSUTES. 

Electrolysis: — This is the most effective and suc- 
cessful method of treatment, and should be performed 
to depilation. Its action is permanent. (F.) 

The growth of the neighboring fine hairs appears 
to be stimulated by the electricity, hence the opera- 
tion must be repeated. When carefully performed 
little scarring will result. (Vn.) 

Epilation: — This consists in removing the hairs and 
inserting and rotating in each hair follicle a glover's 
needle which has been dipped in carbolic acid. (Kp.) 

Depilatory Powders: — These agents commonly 
contain Arsenic Tersulphide, Barium Sulphide, Cal- 
cium Sulphide or Quicklime. They are not to be re- 
lied upon, being temporary in effect. They, moreover, 
cause a renewed growth of coarser hair, and redden 
and inflame the skin. When for any reason they may 
be required, the following can be employed : 

"Rusma of the Turks." — Orpiment 1 part, quick- 
lime or chalk 10 parts, starch 10 parts. (F.) 

Delacroix's " Poudre Subtile." — Orpiment 4 parts, 
quicklime 30 parts, powdered gum 60 parts. (F.) 

"Reviel's Mixture:" 

Calcii Sulphid., 3 v. 

Ess. Limon., gtts. xx. 

Amyli Glycerit., 

Amyl., aa ^iiss. 

Duhring recommends : 

Barii Sulphid., 3"- 

Amyli, 

Zinc. Oxidi, aa 5i n - 



HORDEOLUM. 311 

Or, 

Sodii Sulphid. , 3* 1 - 

Cretse Praep., gvi. (F. ) 

The following is said to be in vogue in Turkey : 

Arsenici Trisulphuret., 3ii- 

Calcis Vivi, 3"- 

Amyli, 3^ _v - 

Aq. Bullient., q. s. (Vn.) 

These powders are made into a paste and applied 
to the skin; as soon as dry they are washed off. The 
last is allowed to remain on from five to ten minutes, 
or until a tingling sensation is produced, then the 
skin is washed and powdered with starch. 



HORDEOLUM. 

Warm Fomentations or Hot Stupes afford the 
most relief and hasten suppuration. (N. O.) 

Nitrate of Silver: — Applied early will abort; a so- 
lution of grs. v— gi, is recommended by Bull, and one 
of grs. xx— xl-^i by Roosa. 

Hydrarg. Oxidi Flav. — An ointment of grs. v— gi 
rubbed in is useful in the beginning of the affection. 
(Ro.) 

When the swelling points it should be punctured 
with a Baer or Graefe knife. (N. 0.) 

Errors of refraction should be investigated as they 
may act as a cause. 



HYDROCELE. 

Tr. Iodine: — After evacuating the sac, inject one- 
half to one drachm of a tincture made with crystals 



312 DIGEST OF EXTERNAL THERAPEUTICS. 

of iodine 1 part to 19 parts of alcohol 95 per cent.; 
this is allowed to stand uncorked for a few days. In 
infants a weak solution of iodine or collodion applied 
externally will cause the hydrocele to disappear. (CI.) 

Another method for the use of iodine is the follow- 
ing : Puncture the sac with a trocar and allow about 
one-third of the fluid to flow away, then inject about 
three-quarters to 1 drachm of a one per cent, solu- 
tion of Cocaine ; after an interval of five minutes the 
fluid is drawn off and tincture of iodine pure or mjxed 
with one-third water is injected, and the whole evac- 
uated after five minutes. (Sj.) 

Injection of iodine causes great pain and swelling 
with refilling of the sac, which will require rest in bed 
for a few days with the use of hot fomentations and 
anodynes, but the results are generally satisfactory. 
Contra-indications to its administration are the 
presence of pus or blood in the effusion, and thicken- 
ing or calcareous degeneration of the walls of the 
sac. (CI.) 

Carbolic Acid: — After evacuation, injection of 30 
minims of the liquified acid (carbolic acid 8 parts, 
glycerine 1 part); sloughing never occurs unless a 
greater quantity is used. This procedure is compar- 
atively painless, the inflammatory action much less 
than with iodine, and the patient is not forced to rest 
more than a day, sometimes not at all. (CI.) 

Injection of 30 minims of a freshly prepared solu- 
tion of equal parts of the pure acid and glycerine are 
also recommended. (Sj.) The contra-indications in 
the use of carbolic acid injections are the same as 
those for iodine. 

Treatment by Open Puncture: — The sac is tapped 
in the usual way with a trocar and canula, but the 



HYSTERIA. 313 

latter is left in situ to act as a drain ; a light cotton 
dressing and a slightly compressing bandage is then 
applied. A fenestrated drainage tube may be passed 
through the canula, which is then removed and the 
tube left in its place. For two or three days the sac 
is irrigated with a mild antiseptic solution, and at 
the end of three days the tube is shortened and finally 
removed. (T. 96. ) 

Another method, viz: Introduce a trocar into the 
lower part of the sac and evacuate the contents, then 
wash out the cavity with a 3—5 per cent, solution of 
carbolic acid. The trocar is now pushed through the 
sac wall and brought out at its upper end, a fenes- 
trated drainage tube is passed through the canula 
and the exudations thus allowed to escape without 
accumulating ; antiseptic dressing should be applied 
and the tube removed on the eighth day. No anaes- 
thesia is said to be necessary. Cicatrization requires 
from eight to ten days. (T. 96.) 

Ammon. Chloride:— Lint saturated in solutions of 
grs. x-^i and kept continuously applied is used with 
advantage in congenital hydrocele. (Al.) 

After injecting iodine or carbolic acid a certain 
amount of manipulation of the part must be made in 
order to bring the injected fluid in more intimate con- 
tact with the tissues. 

HYPERHIDROSIS. 

(See Bromidrosis.) 

HYSTERIA. 

The Rest Treatment, which has been successful in 
the hands of Dr. S. Wier Mitchell, consists in Isola- 
tion, Rest, Diet, Massage, and electricity. The fol- 



314 DIGEST OF EXTERNAL THERAPEUTICS. 

lowing is a general outline of the method : The pa- 
tient should be removed from previous surroundings, 
away from all relations and friends, even correspond- 
ence being interdicted for a time. The next essen- 
tial is an intelligent and sensible nurse, the selection 
of whom is a matter of great importance ; she must 
not only be agreeable and congenial to the patient, 
for it must be remembered she is to be her constant 
and only companion for some months, but she must 
also possess tact, judgment, and firmness. Under the 
nurse's care the patient is put to bed and kept in a 
condition of absolute rest, even reading and self -feed- 
ing at first being prohibited. Massage is used daily 
at the commencement for short periods, which are 
gradually increased until it is continued for an hour. 
Faradism is also administered in association with 
massage ; but these measures are discontinued during 
menstruation. The diet during this period is milk, 
used by some skimmed, but unskimmed milk diluted 
with aerated water is preferable; from 4-6 ounces are 
given every two hours. This diet is continued as a 
rule for a week or ten days, when a chop, raw 03^ster, 
with a cup of tea or coffee, are added at luncheon, later 
an egg and bread and butter at breakfast ; the milk 
is continued every two hours. 

The nurse should give the patient a thorough 
sponge bath daily. In a month or six weeks the pa- 
tient is allowed to sit up for a short time, after that 
for a longer period, increasing each day, until the 
whole day is spent out of bed. This return from the 
long rest in bed must be very gradual. Later, the pa- 
tient is taken out for a drive, then, in time, for a 
short walk, then gradually for longer walks, each 
time increasing the distance, until long distances are 



ICHTHYOSIS. 315 

covered with little fatigue. As a rule, about three 
months will be necesasry to carry out this treatment, 
which has given most satisfactory results. (S. W. M.) 
(For a fuller description the reader is referred to 
Weir Mitchell's book, "Fat and Blood," and Good- 
no's V Practice of Medicine.") 



ICHTHYOSIS. 

Treatment, though largely palliative, must be 
active and continuous. The skin should be kept 
moist and supple by frequent warm baths with 
alkalis and soap, the free use of Russian baths, and 
by prolonged warm baths followed by inunctions of 
vaseline, glycerine, lanolin, or oil. 

Sapo Viridis: — This may be rubbed in twice daily 
for four or six days, during which period the patient 
should not bathe; four or five days after the last rub- 
bing, when the epidermis begins to peel, a bath is to 
be administered followed by some simple ointment, 
such as oil of almonds, glycerine, pure or diluted, or 
the following : 

Adipis Benzoat., giv. 

Ung. Petrolii, %i. 

Glycerini, Qiv. (Vn.) 

Naphthol: — 5 per cent, ointment, or 2 per cent, in 
spirits of soap. (Kap.) 

Resorcin: — 3—20 per cent, ointments well rubbed in 
and covered with bandages, have been successful. 
(Ja.) Brocq recommends the following, to be rubbed 
in at night and removed with soap in the morning : 



316 DIGEST OF EXTERNAL THERAPEUTICS. 



Acid. Salicylici, 




Acid. Tartarici, 




Resorcin., 


aa 5i- 


Sulphur. Praecipitat., 


5iss 


Adipis, 


Si- 


Lanolini, 


Siii. 



(Vn.) 

Ichthyol in combination with Salicylic Acid and 
Sulphur may be emplo3 T ed as follows : 

Ichthyol, 3ii _ i v - 

Acid. Salicylici, 3 1 - 

Sulphur. Prttcipitat., 3 n - 

Adipis. ^iv- 

To be applied night and morning and washed off with Iththyol 
Soap. 

Potass. Iodide: — The following is said to act well: 

Potass. Iodid., grs. xx. 

Ol. Bubuli, 

Adipis, aa 3 SS - 

Glycerini, 5i. (J. C. S.) 

Cod Liver Oil by inunction and Sulphur Oint- 
ment are both recommended. 

ICHTHYOSIS HYSTRIX: 

The treatment is essentially that of any warty, 
non-malignant growth. The patches, if not large, 
may be softened by poultices and then treated with 
Caustic Potassa, Chromic Acid, or Glacial Acetic 
Acid, or the growths may be removed by the dermal 
curette or by excision. (Vn.) 

Thuja: — The fluid extract painted on has had good 
effect. (Vn.) 

Salicylic Acid: — A 20 per cent, plaster or a satur- 
ated alcoholic solution is recommended after the re- 
moval of the horny covering. (B. H.) 



IMPETIGO. 317 



IMPETIGO. 

According to Duhring, this affection tends to spon- 
taneous recovery, and beyond the use of a mild stim- 
ulating ointment no treatment is required. 

Iodoform or Salicylic Acid Ointments are used by 
Hardaway. (Hd.) 

The following line of treatment is suggested by Van 
Harlingen : Poultices rendered antiseptic by the ad- 
dition of a little Boric Acid should be used to remove 
the crusts, the entire surface of the body should be 
frequently cleansed with warm water and Corrosive 
Sublimate Soap, then compresses wet with a satur- 
ated solution of Boric Acid or of Bichloride 1-2000, 
should be applied to the diseased points. If ulcers 
form beneath the crusts they should be cleansed with 
Hydrogen Peroxide and dusted with Dermatol, 
Europhen or Aristol, or some antiseptic ointment 
may be applied. 

IMPETIGO CONTAGIOSA. 

Children suffering from this disease should be kept 
from school and separated from other children. 

Hydrarg. Ammoniat.: — This remedy is very gener- 
ally used by dermatologists, and, together with 
cleanliness, in most instances is all that will be 
required. It is employed in ointments of 5 (Kp.) — 
10-15 grains to the ounce. (Hd.) 

Bismuth Subnitrate: — With vaseline or cold cream, 
a drachm to the ounce. (Al.) 

INFLUENZA. 

(See Acute Rhinitis.) 



318 DIGEST OF EXTERNAL THERAPEUTICS. 



INGROWING TOE NAIL. 

The following method, it is claimed, will result in a 
permanent cure : 

1. Remove injurious pressure, and order careful 
measurement for shoes, the uppers of which should 
be of a less unyielding nature than usual; during 
actual treatment the patient should wear canvas 
shoes. 

2. Wash the feet with warm water and soap, then 
soak for fifteen minutes in bichloride of mercury 1— 
4000 ; repeat this daily for four days. 

3. A small piece of antiseptic gauze is to be grad- 
ually and gently inserted between the nail and over- 
lying tissue ; this must be done gently, otherwise it 
is very painful ; the gauze should be removed before 
washing. 

After this the tissues will become considerably sep- 
arated from the nail, which can be trimmed where in 
contact with the soft parts. After soaking, the 
gauze is to be inserted as before. Within a week, it is 
said, the parts will have assumed almost a normal ap- 
pearance, and the patient will be able to go about. 
The gauze should be continued for some weeks. 

A modification of this plan has been found useful, 
viz : In place of the soaking, apply a compress satur- 
ated in a solution of carbolic acid or perchloride of 
iron and cover the same with rubber tissue. After 
two days' application, the gauze may be used as 
above and the nail trimmed. (T. 98.) 

The following, suggested by Dr. W. 0. Terry, is 
also said to be successful : Saturate a small piece of 
absorbent cotton in a solution of Liquor Potassse 1 



INGROWING TOE NAIL. 319 

part to 4 of water ; then, with the flat end of a direc- 
tor, insert the cotton under, over and above the edge 
of the nail, allowing it to spread over the ulcerated 
hypertrophied tissues ; next freely apply collodion 
over the whole, including the inflamed surface ; after 
this, with a long, narrow strip of surgical isinglass 
plaster, attach an end close to the nail on the swollen 
part and bring it around the toe two or three times, 
drawing the hypertrophy away as much as possible ; 
if the case is bad, it will require four or five dressings, 
which should not be changed under forty-eight 
hours. (Hel.) 

An old method, which wall sometimes afford relief 
in the earlier stages, consists of scraping in a line from 
the matrix to the extremity of the nail ; the external 
la} r er may be thus removed ; when the middle is 
reached there will be sensitiveness and the scraping 
must cease ; a deep notch is now cut in the extremity 
of the nail. The ingrowing parts are now to be 
partly raised with a probe and small bits of tinfoil 
inserted ; a hole should be cut in the boot to relieve 
pressure. This process of scraping and notching 
should be continued for several weeks, when a cure 
will result. (Hel.) 

Collodion: — Pack cotton firmly under the free edge 
of the nail with a flat probe passing between the nail 
and the granulation, raising the former as far as pos- 
sible ; the cotton having been thus packed under and 
around the nail, saturate the entire mass with collo- 
dion ; after drying apply a few strips of adhesive 
plaster. (Al.) 

Nitrate of Silver: — Apply a sharp-pointed crayon to 
the base or under the surface of the granulations, 
then insert a small piece of lint soaked in black wash, 
and envelope the toe in water dressing. (Al.)' 



320 DIGEST OF EXTERNAL THERAPEUTICS. 

Tannic Acid: — 1 part to 6 of water, dissolved by 
gentle heat and painted on soft parts twice daily has 
given good results. (Al.) 

Calendula: — Very useful for the relief of inflamma- 
tion ; compresses soaked in a solution of 1 part to 5 
of carbolized water may be applied with good effect. 
(M. H.) 

Alum: — A solution of 6 drachms to 1 ounce of hot 
water is very effective for inflammations. (W. C.) 

Cocaine: — This remedy is most useful for the relief 
of pain in dressing, also after applying a ligature 
around the toe; it may be given hypodermically, and 
thus render removal of whole or part of the nail en- 
tirely painless. (Tre.) 

Antiseptic dusting powders will be found useful in 
ulceration notably Bismuth. Subnitrate. (Al.) 

Removal of the nail is sometimes necessary. 



IRITIS. 

Local or mechanical treatment is of the greatest 
importance to prevent adhesion of the iris to the cap- 
sule of the lens ; this is accomplished by mydriatics. 

Atropine Sulphate: — This is commonly used, and in 
most cases preferred to other mydriatics, on account 
of its sustained action ; a drop of the 1 per cent, 
solution is placed on the outer surface of the. con- 
junctiva of the lower lid, the patient holding the head 
back so that the outer canthus is lower than the 
inner. In acute cases of plastic iritis one drop of a 1 
per cent, solution should be dropped in the eye every 
two hours during the active stage. (Mac.) 

Scopolamine: — A solution of 2 grains to the ounce 



IRITIS. 321 

of distilled water, is a better mydriatic in persons 
over 50 years of age, and in cases where glaucoma 
is threatening, as atropine will precipitate an attack 
of the latter and will make it worse if present. This 
mydriatic is more active than atropine and will tear 
up adhesions quicker. (Boyle.) For quick action, 
which is necessary in plastic iritis, scopolamine hy- 
drobromate, in solutions of y 1 ^ of 1 per cent., is to be 
preferred to atropine, using 2 drops at a sitting, re- 
peating as necessary. (T. 98.) 

Cocaine Hydrochlorate: — 2 per cent, solutions are 
used to relieve pain. (T. 98.) It is frequently com- 
bined with atropine, not only for its anaesthetic 
effects, but because it assists in dilating the pupil by 
its action on the iris and by increasing the absorbing 
power of the cornea. (Al.) 

Duboisin Sulphate: — One-half per cent, solutions 
may be used when atropine causes irritation of the 
skin or conjunctiva. (T. 98.) 

Hyoscyne Hydrobromate: — One drop of a 1 per 
cent, solution may be instilled in cases where the ad- 
hesions are so strong that they resist the action of 
atropine. It is a very powerful remedy, and should 
only be used by the physician himself; the action may 
be kept up by atropine. (Mac) 

Cold: — Applicable in three ways ; in the first place, 
tie a piece of tape around the patient's head and to 
it attach a square of linen which covers the inflamed 
eye, a basin of ice water is placed conveniently near 
and from it the square of linen is kept constantly 
moistened. The second method consists of the appli- 
cation of a pad of cotton wool which has been laid 
upon a block of ice and which is changed as soon as 
it ceases to give the sensation of cold. A block of ice 

22 



322 DIGEST OF EXTERNAL THERAPEUTICS. 

is placed near the bed-side and two pads kept in use, 
one cooling on the ice while the other is on the lids. 
The third plan is a modification of Leiter's coil, being 
the same apparatus, but of much lighter construction 
and especially adapted to this purpose. (N. O.) 

Heat: — May be applied either in the moist or dry 
form. Several folds of lint are dipped in hot water, 
squeezed out as dry as possible, applied to the lid and 
covered with oiled silk. This dressing is then packed 
in with a thick layer of dry cotton heated by contact 
with a can or pail containing hot water, and band- 
aged in position. Another and equally effective way 
consists of the rapid application of a fold of linen 
which has been wrung in hot water and which is 
rapidly replaced as soon as cool. Hot infusion of 
Chamomile Flowers or Poppies are permissable, also 
Conium Lotion, 1 drachm of the extract to 1 pint of 
water; or Belladonna in the same proportions. Hot 
applications are useful during the early stage of the 
disease (Ro.), and may be ordered two or three times 
a day, for a half hour at a time. It is advisable 
when the skin is sensitive to protect the lid and 
neighboring parts with vaseline. (N. 0.) 

Dry heat can be applied by covering the lid with a 
pad of cotton which has been heated by contact with 
the outside of a vessel containing boiling water. 
(N. 0.) 

Local Abstraction of Blood: — A time-honored rem- 
edy, may be used if pain and vascular injection is 
very severe. Natural or artificial leeches may be 
used. (Ro.) 



INSOMNIA. 323 



INSOMNIA. 

Warm or Tepid Baths at night, Massage, or 'Wet 
Pack are all of value. (Gn.) 

Injections of Hot Milk high into the bowel is use- 
ful in cases of alcoholism and insanity. 



INTERTRIGO. 

(See Erythema Intertrigo.) 

KERATITIS. 

Atropine: — Renders great service by contracting 
vessels, it is useful in all forms according to the con- 
dition. (Ro.) 

E serine: — In the phlyctenular variety, one five-hun- 
dredth solution dropped into the eye three times a 
day will be found valuable in hastening the healing 
of the ulcers, and in relieving the photophobia, by 
contracting the pupil and reducing the tension of the 
eyeball. As iritis is seldom a complication, this rem- 
edy is generally safe. (Mac.) 

Pyoktanin: — Solutions of 1—1000 in the parenchy- 
matous and sloughing forms are highly praised as 
well as discredited. (Al.) 

Cocaine: — Alone or in combination with atro- 
pine to relieve pain and check inflammation. (Al.) 

Gallicine: — In superficial forms, the powder, which 
is very light, may be dusted on, the application being 



324 DIGEST OF EXTERNAL THERAPEUTICS. 

made twice a week ; a smarting sensation follows, 
which soon passes off or which can be relieved by 
cold compresses or cocaine. (F.) 

Hot Stupes: — Of great value, especially when there 
is sloughing, in which case they are indispensable. 
They may be of service in all forms according to 
indications. (Al.) 

Cauterization: — The actual cautery or pure carbolic 
acid is effective in the suppurative variety. (Ro.) 

Iodoform: — Dusted on or applied as an ointment 
(sHij) is well thought of by some when there is 
sloughing, but should not be relied upon to the exclu- 
sion of other remedies. (Al.) 

Hydrarg. Oleat. : — The ointment by inunction in the 
diffuse form may be thus employed for months, but 
with great caution. (Ro.) 

Aristol: — The powder has been employed with suc- 
cess in clearing of opacities of the cornea in intersti- 
tial keratitis . ( Sm . ) 

Mercury: — Finely levigated Calomel as a dusting 
powder or the Yellow Oxide as an ointment (grs. 
ss-iv-^i) are recommended for chronic cases. (Al.) 



KELOID. 

Treatment is unsatisfactory. Removal by the 
knife is generally followed by recurrence. 

Electrolysis is probably the best means. (Hd.) 

Thiosinamine: — 10—15 minims of a 10 per cent, so- 
lutions hypodermically, have been employed with 
good results. (Hd.) 

Vidal's Method: — Deep parallel incision dividing 
the vessels, producing obliteration, may have a bene- 



LARYNGISMUS STRIDULUS. 325 

ficent effect, if done repeatedly. It usually relieves 
pain. (B. H.) 

Anodyne Applications may be required for the re- 
lief of pain. 



LARYNGISMUS STRIDULUS. 

Raise the child and promptly immerse it in a Warm 
Bath, sponging the throat at the same time with hot 
water, and apply a Mustard Sinapism to the back of 
the neck. (Bos.) 

Anaesthetics will stop an attack immediately; a 
few drops of Ether will generally answer. 

Chloroform may be used for the convulsions which 
may follow. (Jac.) 

Ice to the epigastrium or in the rectum sometimes 
will afford prompt relief. 

Cold Water dashed on the face with considerable 
force may be tried to excite respiration. 

Irritation of the Pharynx with the finger or with a 
feather to induce vomiting will relax the spasm. (Gn.) 

Artificial Respiration should be employed when 
spasm is prolonged and death seems imminent. (Gn.) 

Chloral Hydrate: — 4-8 grains by rectal injection 
are recommended for the convulsions which not un- 
commonly follow an attack. (Jac.) 

The child should be placed in a semi-recumbent po- 
sition, with free access to the air, and the tongue 
should be watched, lest it fall back into the pharynx 
and still further impede respiration. 

The condition of the gums and bowels should be in- 
vestigated as possible causes. 



326 DIGEST OF EXTERNAL THERAPEUTICS. 



LARYNGITIS, ACUTE CATARRHAL. 

The temperature of the room should be evenly 
maintained at about 70° F., and the atmosphere 
kept moistened with Steam. 

Heat to the throat increases secretion, and relieves 
congestion ; it is applicable to most cases. Flannel 
cloths wrung out in hot water and covered with 
oiled silk are the best methods of application ; poul- 
tices may be used, but they are heavy and inconve- 
nient. A hot foot bath is often beneficial at the 
onset of the disease. (Ga.) 

Cold Applications by means of the Ice Bag or Cold 
Wet Cloths, frequently changed, will often cut short 
an attack if undertaken early enough (Bos.); they 
are also often of service in grave forms of the disease 
attended with swelling of the submucous tissue. 

Inhalations of warm medicated vapors are of ser- 
vice. 

The following are to be used with boiling water : 

Tr. Benzoin Comp., gss— i to Oj. 

Turpentine, p, poured on the surface of a pail of 
boiling water. 

Thymol, 1—1000, useful in exanthematous forms 
with purulent exudation. 

Oil of Origanum, a few drops to Oj. 

Oil of Cubebs, indicated when there is relaxation of 
the mucus membrane and hypersecretion, 10 drops to 
gi, add a small quantity of magnesia carbonate; of 
this mixture take 1 drachm to half a pint of water. 

Lupulin, grs. v—^i strongly recommended if there is 
great pain and rapid progress of the disease. 



LARYNGITIS, ACUTE CATARRHAL. 327 

Astringent sprays are used by Bosworth as follows: 

Liq. Ferri Persulphatis, gtts. v-x— |i. 

Argent. Nitras, grs. ii— v— §L 

Zinci Chloridum, grs. v— x-gi. 

Dobell's Solution, or some other mild alkaline 
spray, should be employed for cleansing when there is 
an excess of mucus. 

For the administration of steam inhalations em- 
ploy one of the special appliances constructed for this 
purpose, or an ordinary hot water kettle with a piece 
of rubber piping attached to the nozzle ; for want of 
something better a common tin funnel placed over a 
cup of hot water will answer. 

The following measures, stated in order of their 
importance, are suggested by Bosworth for hoarse- 
ness and complete loss of voice, especially in singers 
and public speakers, where speedy relief is a matter 
of importance. There is no definite method, how- 
ever, by which relief can be obtained in a given pe- 
riod : 1. Absolute and total rest of the voice ; this is 
literal, even whispering is to be avoided as much as 
possible. 2. Confinement to an apartment the tem- 
perature of which should be evenly maintained at 68° 
or 70°, not higher. 3. Let the atmosphere be im- 
pregnated with steam from a spirit lamp. 4. Apply 
an ice bag to the surface of the throat. 5. By means 
of an atomizer, spray the larynx with a solution of 
nitrate of silver, grs. v-^i, repeat a second or a third 
time during the day, the strength of the solution 
and the interval of application being governed by the 
appearance of the parts as shown by the laryngoscope . 
6. Reduce turbinated bones if swollen by chromic 
acid. 7. If there is acute inflammation of the 
pharynx douche the part thoroughly with the post- 



328 DIGEST OF EXTERNAL THERAPEUTICS. 

nasal syringe and apply nitrate of silver, grs. xxx-gi. 
(In conjunction with these measures -5-^ gr. of 
aconitine hourly for three doses, then every two 
hours until constitutional effects are produced, and a 
saline purge.) (Bos.) • 



LARYNGITIS, CHRONIC CATARRHAL. 

Many writers regard this disease as always sec- 
ondary to some other chronic affection of the upper 
respiratory tract, as such treatment should also be 
directed to the primary disease. 

Direct instrumental indications require the per- 
sonal attention of the physician. Inhalations and 
insufflations may be carried out by the patient or an 
attendant at home. 

Alkaline Sprays tend to increase secretion and fa- 
cilitate removal of adherent mucus ; for this purpose 
employ the following, each in the proportion of 5 
grains to the ounce of water (Solis Cohen) : Ammo- 
nium Chloride, Sodium Biborate, Sodium Bicarbo- 
nate, Sodium Chloride, Potassium Chlorate; Tar 
Water may be used as a menstrum instead of distilled 
water. A few drops of some aromatic may be added 
to the solutions to make them more agreeable. (Pp.) 

Astringent Sprays are indicated when secretion is 
excessive. The following are to be employed with one 
ounce of rose water : Alum, grs. v., Tannic Acid, grs. 
ii., Lead Acetat.,grs. ii., Ferric Chloride, gr. i., Silver 
Nitrate, grs. ss., Zinc Acetate, grs. v., Zinc Sulphate 
or Sulpho-Carbolate, grs. ii. (Pp.) Bosworth con- 
demns vegetable astringents, iodine, carbolic acid and 
creosote as ineffectual, and uses the following, to 1 



LARYNGITIS, CHRONIC CATARRHAL. 329 

ounce of water, preference of selection being given 
according to order : 

Argenti Nitras, grs. v— xx. 

Zinci Sulphas, grs. v— xx 

Zinci Chloridum, grs. ii-vi. 

Liq. Ferri Persulphatis, Min. x— xxx. 

Cupri Sulphas, grs. iii-x. 

Steam Inhalations used at home daily are service- 
able in cases of hyperesthesia of the mucous mem- 
brane. The patient should remain indoors for half 
an hour after use. The following are to be employed, 
all in the proportion of one teaspoonful of the mix- 
ture to one pint of hot water : 

Tr. Benzoin Comp., ^xxii. 

Ol. Pini Silvestris, ^ii. 

Stimulating and soothing. 
Or, 

Ol. Pini Silvestris, 

Magnesiae Carb. Levis, aa .^i. 

Aq. Destill., ad. ^ iii. 

This forms a mildly stimulating and resolving ap- 
plication. The same formula may be employed with 
the addition of 5 grains of camphor. 

Other useful formulae are as follows : 

01. Eucalypti., 3 i— iii. 

Magnesiae Carb. Levis, grs. xxx-xc. 

Aq. Destill., ad. giii. 

An agreeable stimulant with sedative effect : 

Creosoti, ^ ss. 

Magnesiae Carb. Levis, ^iss. 

Aq. Destill., ad. ^ iii. 

Useful for chronically congested conditions : 

Benzol., 3 ii. 

Ol. Cassiae, Mvi. 

Magnesiae Carb. Levis, ^i. 

Aq. Destill., ad. ^ iii. (L. B.) 



330 DIGEST OF EXTERNAL THERAPEUTICS. 

If topical treatment of a more decided character is 
indicated, solutions applied with a brush or powders 
should be used, only, however, in the hands of an ex- 
pert, as spasm of the larynx is liable to be excited by 
medicinal applications when made for the first time ; 
they should not be employed until tolerance has been 
established. The use of cocaine will greatly assist in 
allaying irritation . ( L . B . ) 

Among the stronger local applications which have 
been suggested for intra-laryngeal treatment a»re the 
f ollowing : 

Iodoform, indicated in ulceration, finely pulverized, 
alone or with Bismuth equal parts, with Morphine 
grs.ii-x to the gi of iodoform (Ty.), or in an ethereal 
solution. 

Nitrate of Silver grs. xxv, rose water §i, recom- 
mended by Solis Cohen in obstinate and protracted 
cases (Pp.), condemned by Lennox Brown, but re- 
garded by Bosworth as probably the best. 

Iodine, gr. i, glycerine ^i (L. B.), or Iodine, grs. v in 
from 1 drachm to 1 ounce of alcohol; applications 
are made daily commencing with the weaker solu- 
tions; only one puff is to be applied, the patient inspir- 
ing. Holding cold water in the mouth may control 
spasm. The previous use of a strong solution of co- 
caine will usually act as a preventive. (Gn.) 

Chloride of Iron, 3ss— 3i, with water, gi, has been 
used in the hoarseness of professional singers ; a sin- 
gle application, it is said, will often put the parts in 
good condition. (Al.) 

Faradism is of benefit in restoring the tone and 
power of the voice. (L. B.) 

Cold Wet Compresses at night and Iodine painted 
on the throat over the thyroid cartilage are useful 
adjuncts. (L. B.) 



LARYNGITIS, ACUTE (EDEMATOUS. 331 

Lactic Acid, Nitrate of Silver or Chromic Acid 
fused on the end of a silver probe, applied with a 
properly hooded porte-caustique, may be applied in 
some cases when there is considerable hypertrophy 
at the posterior insertion of the chords and anterior 
face of the commissure, giving rise to watery excres- 
cences. The use of caustics is generally condemned 
except for the above condition, which is occasionally 
observed. (Bos.) 



LARYNGITIS, ACUTE (EDEMATOUS. 

(CEdema Glottidis) 

Such local depletion as can be obtained by Free 
Scarification of the inflamed membrane is the first 
indication. This can be accomplished by Tobold's 
concealed lancet or any other laryngeal knife conve- 
nient, failing this with an ordinary curved bistoury 
with the blade wrapped in plaster or thread up to 
within a quarter of an inch of its point. The scari- 
fications should be used freely three times a day both 
along the face of the epiglottis and the swollen ven- 
tricular cords. (Bos.) 

Ice Applications to the neck have been employed 
with good results ; the patient sh< mid also be allowed 
to suck ice. 
Cocaine Sprays are advised. (Os.) 
Steam Inhalations may relieve. (Bos.) 
Tracheotomy should be performed if no relief is ob- 
tained. The high rate of mortality, according to 
Osier, is due to the fact that in many instances the 
operation is delayed too long. 



332 DIGEST OF EXTERNAL THERAPEUTICS. 

LARYNX, TUBERCULOSIS OF. 

(See Tuberculosis.) 

LENTIGO— FRECKLES. 

The remedies for chloasma are also applicable. 

Copper Oleate: — Grs. v-3-gi, with lanolin or lard is 
excellent. (Sh.) 

Salicylic Acid: — Grs. iv-^i, in an ointment. (Sh.) 

Hydrarg. Bichlorid.:— Used in strengths varying 
from one-half to 4 grains to the ounce of water, al- 
cohol or almond oil. These solutions may be left in 
contact with the skin several hours. (B. H.) 

The following are useful combinations : 

Hydrarg. Bichlorid., grs. iss. 

Tr. Benzoini., ^iiss. 

Glycerini, 3 ii. 

Aq. Rosse, ^vi. (Sm.) 

Or the following paste of Unna, which is to be ap- 
plied once daily: 

Hydrarg. Bichlorid., grs. iii. 

Zinc. Oxidi, gii. 

Bismuth. Oxychlorat., 3 SS - 

Dextrini, 

Aq. Destill., aa, 3ij- 

Glycerini, 3 ni - (Sh-) 

Carbolic Acid: — Touch each spot with the pure 
acid ; as a result, the epidermis will peal off and leave 
a red spot which will become normal in a few days. 
(Sh.) 

Zinc Sulpho-Carbolate: — A paste for application 
with a brush may be made as follows : 



LEPROSY. 333 

Zinc. Sulpho-Carbolat., grs. v. 

Alcohol., 3 SS - 

Collodii, %\. 

Hardaway recommends: 

Hydrarg. Ammon., 

Bismuth. Subnitrat., aa gi. 

Ung. Aq. Rosae, ^j. (Ja.) 



LEPROSY. 

For ulceration, ordinary antiseptic methods should 
be employed. Iodoform, Aristol, Salol, Boracic Acid 
may be dusted on after cleansing with antiseptic so- 
lutions. (B. H.) 

Oil of Anacardium: — Used in tropical countries, and 
as a local stimulant may be applied pure, but is bet- 
ter if used at first diluted with 3 parts of almond 
oil ; applications being made to the anaesthetic spots 
until a blister is formed, also to tubercles until they 
open; the lesions are then dressed with gurjun oil. 

(Al.) 

Gurjun Oil: — Recommended on good authority ; 
the formula for its use is 1 part of the oil to 3 of lime 
water; churn well together so as to make a cream 
and apply to the ulcers. (Yn.) Equal parts of the 
oil and lime water are also employed. (Al.) 

Chaulmoogra Oil:— By inunction pure or with vas- 
eline or lard ; spread on cloths and apply to parts. 
Under this drug improvement may be looked for. (F.) 

Ichthyol: — Applications varying from 10-60 per 
cent, reported by Unna to have given good results. 

Mercury Perchloride: — Intra-muscular injections 
of \ grain were used in two cases with remarkale im- 



334 DIGEST OF EXTERNAL THERAPEUTICS. 

provement (T. 97.); it is believed to be a valuable 
agent. 

Serum Treatment:— Claims have been made for the 
treatment of de Dios Carrasquilla, but its curative 
power has not yet been demonstrated. (F.) 

Chrysarobin: — Recommended by Unna in the fol- 
lowing combinations, to be rubbed into all the lesions 
except those of the hands or face: Chrysarobin and 
ichthyol of each 5 parts, acid salicylic 2 parts, simple 
ointment 100 parts ; on the hands and face Pyrogal- 
lic Acid is substituted for the chrysarobin ; (to coun- 
teract bad effects of the drug 30 drops of dilute hy- 
drochloric acid are administered daily, for women 
and children); Resorcin is sometimes substituted for 
chrysarobin. 

Electro- Cauterization: — Has been used as a means 
of reducing leprous nodules ; each tubercle should be 
cauterized internally by single or multiple points or 
by electro-caustic bars when the surfaces to be de- 
stroyed are large. (T. 98.) 

Excision: — Followed by the application of pure 
Carbolic Acid, is a method which has been employed 
with a view of relieving the disfiguremnets ; Tannin 
is applied to the surface after the carbolic acid in or- 
der to form a crust and to protect the action of the 
acid. The knife or scissors are used for excising. (B. 
M.J., 6, 9, 88.) 



LEUCORRHCEA. 

(Compare Endocervicitis and Endometritis.) 

Being a symptom, treatment is obviously to be di- 
rected toward the cause; when of cervical origin, it is 



LEUCORRHCEA. 335 

that of endocervicitis, endometritis and erosion. Dis- 
placements, hypertrophied cervix, lacerations, polypi, 
cysts and vaginitis, dyscrasia, ascarides in children 
are also causes. 

Douches: — Hot water douches are of great value 
in all forms and should be used daily ; tepid salt wa- 
ter is beneficial for simple forms of catarrh. (Cp.) 

Hydrastis: — One of the most useful remedies. The 
following are recommended for injection : 

Fid. Ext. Hydrastis, 3i. 

Aq. Destill., Oss. 

Or, 

Fid. Ext. Hydrastis, 

Sue. Calendulae, aa ^i. 

Glycerini, % vi. 

Tablespoonful to half a pint of water. (Cp. ) 

Creolini, gtts. xxx. 

Fid. Ext. Hydrastis, ^iiss. 

Two tablespoonfuls to half a pint of water. (T. 97.) 

Borax: — 5—10 per cent, solutions, often very satis- 
factory in alkaline discharges. (F.) 

Boracic Acid: — The powder by insufflation or in so- 
lution with glycerine tampons ; also used in solution 
for injection of 6 drachms to the pint. (R.) 

Tannin: — Used in several ways ; half an ounce with 
half a pint of claret wine forms a good astringent in- 
jection. Also the following : Creosote 3 parts, tan- 
nic acid 6 parts, alcohol 3 parts, water 24 parts. 
A tablespoonful of this mixture with two pints of 
water; inject two or three times a day. (T. 98.) 

Alum: — A very useful and inexpensive remedy ; use 
about 1 drachm to a pint of water for a simple in- 
jection. 

The f ollowing combination is also recommended : 



336 DIGEST OF EXTERNAL THERAPEUTICS. 

Alum, 3 i. 

Zinc. Sulph., ^ss. 

Sod. Biborat., grs. iv. 

Aq. Rosae, ad gviii. (R.) 

Or, 

Alumen. 

Zinc. Sulph., aa gi. 

Potass. Permang., 

Heliotropin, aa gr. i. 

Dissolve this powder in a pint of warm water and use as a 
vagina] douche. (T. 97.) 

Myrrh: — 1 drachm, to an ounce of water often will 
have an excellent effect in simple catarrhal condi- 
tions. (Al.) 

Zinc Sozoiodate: — As a dusting powder or as a 10 
per cent, ointment on tampons. (Al.) 

Grindelia: — An effective remedy, may be combined 
with creolin as follows : 

Fid. Ext. Grindeliae, ^ss. 

Creolini, gii. 

Aq. Destill., q. s. ad g v. (Sm.) 

Loretin: — By insufflation, after a cleansing douche 
this drug has many of the advantages of iodoform 
without its odor ; it is especially serviceable in puru- 
lent and offensive discharges. (T. 96.) 

In some chronic cases, benefit is derived from tam- 
pons soaked in Glycerine of Carbolic Acid 1 part and 
Glycerine of Tannin 4 parts, introduced through a 
speculum. (T. 96.) 

Glycerite of Tannic Acid or Gallic Acid are also 
used for saturating tampons. (Sw.) 
Effective injections, viz : 

Acid. Salicylic, 

Acid. Thymic, aa gss. 
Ess. Amber., gtts. xx. 

Alcohol 90 , gviss. 

Cologn., Jiss. 

Aq. Destill., ^ix. 



UEUCORRHCEA. 337 

Tablespoonful to a quart of water; inject three or four times 
daily. Useful for the suppression of fetor. (Sn.) 

Zinc. Sulphat., 

Alum. Sulphat. aa 5i ss - 

Glycerini, ^ vi. 

Tablespoonful to a quart of hot water for injection. (Sn.) 

The following suppository may occasionally be of 
service : 

Pulv. Catechu, 

Aluminis, aa 3i- 

Ol. Theobromat., q. s. 

Ft. Suppos., No. vi. 
One night and morning. (Sn. ) 

The following douches are to be employed for anti- 
sepsis : 

Hydrarg. Bichlorid., 1-4000-2000, for occasional 
use. 

Carbolic Acid, 1-100 or 1-200. 

Izal, gi-Oj. 

Condy's Fluid, Sulpho-Carbolate of Soda, Creolin, 
Lysol each in the proportion of 1-200. 

Liq. Sod. Chlorinate, ^i-Oj. 

Potass. Permang., grs. xx— Oj water; inject a 
small quantity three times a day as a deodorant 
when discharge is very offensive. (Alb.) 

When sedative douches are desired, the following 
may be employed : 

Liq. Plumbi Subacetat., gii-Oiij. 

Liq. Opii. Sed., gi-Oj. 

Chloral. Hydrat., grs. xx— Oj. 

Sod. Biborat. or Sod. Bicarbonat., ^iii-Oj. (Alb.) 



23 



338 DIGEST OF EXTERNAL THERAPEUTICS: 



LICHEN RUBER. 

Simple ointments, such as Cold Cream or Vase- 
line, when there is no itching. 

Tar Ointments in various forms are indicated, but 
must be used with discretion, as they do not always 
agree. An ointment containing 1—2 drachms to 
the ounce of Oil of Cadi, pure or diluted, with an 
equal quantity of olive oil or cosmoline, is beneficial. 
(B.H.) 

Liq. Carbonis Detergens:— Preferred by Crocker as 
a lotion in the strength of 10 minims to 1 drachm to 
the ounce of water. 

Liq. Picis Alkalinus, made in the following man- 
ner, is used : 

Potass. Caustic, grs. xv. 

Picis Liquidae, grs. xxx. 

Aquae, §iv. 

This should be considerably diluted when first 
used, as it is irritating. (Vn.) 

Naphthol or Thymol: — Grs. x-^ii, with vaseline §i, 
recommended by Crocker ; useful for the itching. 

Unna keeps the patient in bed between blankets, 
and has him rubbed night and morning with this 
ointment : 

Ung. Zinc. Ox. Benzoat, §iv. 

Acid. Carbolici, ^iv. 

Hydrarg. Bichlorid., grs. ii-iv. (Ja.) 

In chronic cases Hardaway uses the following, 
well rubbed in with flannel : 

Sapo. Olivae Prasp., §iv. 
01. Rusci, 

Glycerini, aa ^i. 

01. Rosamarini, ^iss. 

Alcohol., ad. 3viii. 



LOCOMOTOR ATAXIA. 339 

Hot compresses once or twice daily will often re- 
lieve severe cases; emollient and alkaline baths are 
useful in cases where the skin is very irritable. 

The following was recommended by Unna : 



Hydrarg. Cblorid. Corros., 


grs. vii 


Cretae Praep., 


3 iiss. 


Acid. Carbolici, 




01. Olivse, 


aa, 5 v. 


Ung. Zinc. Oxidi, 


£ XV. 


Rub in thoroughly. 





(Sn.) 

Salicylic Acid: — Grs. x-xx to alcohol and water ^i, 
or in an ointment grs. x-xv— §i; a 10-20 per cent, 
plaster is effective in thickened verrucous patches. 
(B. H.) 

Menthol: — Indicated especially when itching is a 
prominent symptom ; use in an ointment, grs. x— xv— 
gi. (B.H.) 

In addition to the above, the more stimulating and 
stronger antipruritic remedies which have been men- 
tioned for eczema may be employed for this affection, 
with the view of relieving the pruritus and causing 
absorption of the lesions. 



LOCOMOTOR ATAXIA. 

Frsenkel's Exercise Treatment: — This method, it is 
claimed, is exceedingly helpful in keeping patients on 
their feet for years, and benefiting those who have 
not walked for a long period to such a degree that 
the powers of locomotion are restored sufficiently for 
the patient to walk about. There are two classes of 
exercises, those performed in bed and those performed 
out. The bed exercises consist of flexion, extension, 



340 DIGEST OF EXTERNAL THERAPEUTICS. 

abduction, and adduction of each leg separately, then 
both simultaneously. The knees and hips are like- 
wise exercised. The patient is asked to place the heel 
of one foot upon the big toe of the other, then place 
the heel upon the knee of the other leg, then slowly 
travel upon the ridge of the tibia to the ankle. These 
exercises are made alternately, first with one leg then 
-with the other, with the eyes open and then with the 
eyes closed, and should be attempted over and over 
again, morning and afternoon, for half an hour at a 
time with frequent rests ; the patient should be en- 
couraged to persist until he succeeds. 
The exercises performed out of bed are as follows : 

1. Place the patient with back to a chair, heels to- 
gether ; let him seat himself slowly in the chair, then 
let him rise in the same careful manner. No cane is 
used ; if he cannot stand attendants on each side 
must support him. 

2. Let one leg be placed at a walking step in front 
of the other, then place back into the original posi- 
tion with great exactness. Repeat the same with the 
other leg. Patient may support himself if necessary. 

3. Walk three paces slowly and with precision. 

4. Rest in standing position with one foot before 
the other with arms akimbo ; flex the knees then 
slowly rise. 

5. Patient exercises as in No. 2 ; advances one foot, 
then return it slowly to original position, then walks 
one step behind the other. This is very difficult, as it 
requires a great deal of balancing power. 

6. Walk twenty steps, as in No. 3. 

7. No. 2 performed with a cane. 

8. Stand with a cane with feet together and hands 
on hips. 



LOCOMOTOR ATAXIA. 341 

9. Stand without cane, feet separated, and make 
various movements with the arms, grasping objects 
or forcing back outstretched hand of attendant. 

10. Maintain same position as in No. 9 ; then flex 
the trunk forward and back, right and left. 

11. No. 9, with feet together. 

12. No. 10, with feet together. 

13. Walk along a parallel line in the floor, patient 
supporting himself with a cane. 

14. Same as No. 13, without a cane. 

Exercises with fingers and arms are recommended, 
based on the same principles. (Gld.) 

Sodium Phosphate: — A hypodermic injection of a 0.1 
per cent, solution has recently been used or the relief 
of the darting pains, which it is claimed to have con- 
siderably diminished. (T. 98.) 

Theine: — Has proved serviceable in relieving the 
pains, large doses hypodermically ; as much as 3 
grains are said to have been given. (F.) 

Electricity — In the treatment of this affection this 
is an agent in reference to which there is a marked 
divergence of opinion. It is condemned by some and 
praised by others; in Germany it is much used, but 
does not appear to be so extensively endorsed in this 
country. It is claimed that if used early enough elec- 
tricity is capable of arresting the morbid process, but 
if cases are not properly selected it will do harm. (Ht.) 

Erb's combined galvanism of the spinal cord and 
sympathetic cervical ganglion constitutes the best 
central application. The negative pole is placed over 
the superior cervical ganglion on one side, while the 
positive is applied to the lumbar region of the spine 
on the opposite side of the spinous processes. A 
current of 6 to 8 milliamperes is passed for one 



342 DIGEST OF EXTERNAL THERAPEUTICS. 

minute and a half. Then the electrodes are changed 
to the opposite sides, that is, the negative electrode 
is placed where the positive was applied and the pos- 
itive to where the negative had been. The current is 
again allowed to pass through the parts one minute 
and a half. The negative electrode is now placed 
over the spinous processes of the cervical vertebrae 
and the positive over those of the lumbar. After this 
the limbs and trunk are treated thoroughly with the 
faradic brush, with a current as strong as can be 
borne without inconvenience. Applications may be 
made on alternate days. (Gn.) 

Static Electricity is also employed with great re- 
lief in some cases. (F.) 

Hydrotherapy: — Is a serviceable measure if used ju- 
diciously. Tepid baths (80°— 90°) combined with 
gentle rubbing are beneficial. Hot and wet packs 
and vapor baths are used, but are claimed by some 
authorities to be harmful. Wet compresses on the 
legs at night will sometimes relieve pain. (Ty.) 

Among the natural springs which enjoy an especial 
reputation for treatment of this disease are Oeyn- 
hausen-Rehme in Minden, and Aix-la-Chapelle and 
Nauheim. The mud and iron baths of Pyrmont, 
Driburg, Elster, Carlsbad, and Franzenbad are men- 
tioned in this connection. 

Massage: — Both by its general effect upon the nu- 
trition and circulation, may from time to time be em- 
ployed with benefit. Disturbances of sensibility often 
improve under this treatment. (F.) 

Bonuzzi's Treatment: — This is described by P. J. 
Mobuis, of Leipsic, as ' 'actually barbarous." It con- 
sists in drawing the feet of the patient, by means of a 
cloth, so far above his head that the knees approach 



LUPUS ERYTHEMATOSUS. 343 

the forehead. Blondell's modification of this treat- 
ment consists in an extension en miniature, approxi- 
mating the patient's bended knees to his chin, and 
holding them in that position for a few moments by 
means of a bandage passing behind the knees and 
about the neck. (T. C, Vol. XI.) 

Suspension: — By means of Sayre's apparatus, first 
tried by Motschutkowsky, of Odessa, was much in 
vogue at one time, but this procedure is attended 
with some danger, especially in heavy patients, and 
those with arterio-sclerosis. Its results have not 
proved as satisfactory as they promised, and like 
many other " cures" it has fallen into disuse. (T. 
C., Vol. XL) 

Mercurial Inunctions: — Advised in syphilitic cases 
and those in which there is a suspicion of specific 
taint; 3-4 grains of blue ointment daily may be 
rubbed in, and a bath should be taken on the seventh 
day ; this procedure may be repeated four or five 
times. The gums should be watched carefully. After 
an interval of five or six weeks or several months a 
second course may be administered. The baths of 
Nauheim and Rehme are advised by Erb during the 
interval of inunctions. (T. C, Vol. XI.) 



LUPUS ERYTHEMATOSUS. 

While in external treatment we look for positive 
effect, it should be remembered that the disease some- 
times disappears spontaneously, with little or no 
scarring; therefore, applications which have a ten- 
dency to disfigure should be avoided. (Pp.) 

Sapo Viridis: — This remedy has been recommended 



344 DIGEST OF EXTERNAL THERAPEUTICS. 

by Hebra and Kaposi, and is at times very useful ; it 
may be used pure or diluted in the proportion of two 
parts with one of alcohol (spts. sapo. kal.); this is 
to be rubbed in energetically once or twice daily. 
The sapo viridis plaster may be used when a more 
active method is desired. After several days the 
soap is to be discontinued and a soothing ointment 
applied. The spts. sapo. kal. may also be employed 
with advantage to cleanse the parts preparatory to 
the application of other remedial agents. (Pp.) 

Carbolic Acid: — Applied pure, forms one of the best 
applications. (Kp.) 

Ichthyol: — Useful in the following formula sug- 
gested by Unna : 

Ichthyoli, J}iv. 

Amyli, J^iv. 

Sol. Albumin. Concentrat., M. v-viii. 

Aquae, ad. %i. 

This preparation dries quickly, and a new coat may be added. 

Hydrarg. Ox. Rubr.-. — An ointment known as 
"Rochard's," composed of 4 grains of iodide melted 
with 10 of calomel, until combination takes place, 
then rubbed up with an ounce of lard ; it is stimulat- 
ing and almost caustic, and is occasionally used on 
small chronic patches. (Al.) 

Glacial Acetic Acid: — A mixture of equal parts 
with glycerine has been found serviceable in small 
patches and seemed to stimulate absorption of de- 
posits. (Pp.) 

Zinc Nitrate — In severe and chronic cases the fol- 
lowing was recommended by Tilbury Fox : 

Zinc Nitrate, 3 iss. 

Distilled Water, 

Glycerite of Starch, 

Flour. aa, £i. 



LUPUS ERYTHEMATOSUS. 345 

Make into a paste and apply; when paste is withdrawn, apply 
poultice; the raw surface left by removal of eschar should be 
dusted with Diachylon or Zinc Oxide Ointment. Reapplication 
may be needed. (F. ) 

Pyrogallic Acid: — Is serviceable when strong reme- 
dies are necessary ; being somewhat caustic in action 
it must be watched ; may be employed 40-90 grains 
to the ounce as an ointment; weaker applications 
should be tried first. It is safer and more satisfac- 
tory when applied in flexible collodion, as follows : 

Acid. Pyrogallic, 3*- 

Liq. Guttae Perchse, 3* v - 

Apply with a brush on patches several times until considerable 
reaction takes place or a crust forms, then discontinue. As soon as 
the crust is removed, repeat the application; if there is much scal- 
ing, 30 grains of Salicylic Acid may be added. (Pp. ) 

Naphthol Sulphur Soap — Excellent for cleansing. 
(Kap.) 

The following lotion is recommended when inflam- 
matory symptoms are marked, and in recent and su- 
perficial forms with little infiltration and no involve- 
ment of the sebaceous glands : 

Zinc. Sulphatis, 

Potassii Sulphid., aa 3 SS - 

Aquae, J iii. 

Alcoholis, ^i. 
The salts should be dissolved separately in water, and the lotion 

added. The parts are to be mopped twice daily for 15 to 30 min- 
utes; if too strong, dilute. (Pp.) 

A stronger application, suitable for cases mentioned 
in the preceding paragraph, as well as when there is 
more infiltration, is as follows: 

Chrysarobin, 3 iss. 

Acid. Salicylici, 

Pulv. Caldminae, aa ^ss. 

^theris, 3 i. 

Collodii, Flex., 3v. (Vn.) 



346 DIGEST OF EXTERNAL THERAPEUTICS. 

Pyoktanin: — Daily application of a saturated solu- 
tion, is of great value in torpid cases. 

Naphthol and Sulphur pastes promoting desqua- 
mation are also useful in the same condition. (T. 98.) 

Chrysarobin: — 40—90 grains to the ounce, as an 
ointment in the same condition as mentioned for pyr- 
ogallic acid ; dangerous for use about the face, as it 
may cause a violent conjunctivitis. (Pp.) 

Caustics: — These are sometimes demanded, but 
weaker applications should always be tried first. 

Caustic Potash : — 1 part to 3-6 water, applied by 
means of a Charpie brush on a stick, forms one of 
the best caustics. (Vn.) 

Linear Scarification: — Used in cases which are ex- 
tensive and much infiltrated ; better than caustics 
and strong applications. Use a fine scalpel or teno- 
tome or multiple scarifier, holding it in the hand like 
a pen. Make a series of parallel incisions, about one- 
sixteenth of an inch apart, and extending entirely 
through the skin; having covered the part with these 
parallel incisions, make another series at right an- 
gles, and even a third obliquely may be made; 
successive patches of an inch square may be operated 
upon daily. The wounds may be dressed with an 
antiseptic powder, such as aristol or europhen. Lit- 
tle scar is left, and the result is more satisfactory 
than any other method of treatment. The skin must 
be frozen by ether or salt and ice before operation. 
(Cr.) 

Erasion by Curette and Scraping Spoon has been 
used in severe cases, but scarification is better. 

Paquelin Cautery: — Heat barely red and run over 
the surface very superficially, then dress with iodo- 
form which forms a crust. After about ten days this 
falls off leaving a smooth pale surface. (Vn.) 



LUPUS VULGARIS. 347 

Electrolysis: — Multiple puncture will sometimes 
give brilliant results. Most cases will require active 
stimulating treatment, yet there are cases where the 
pain and inflammation will demand for a time sooth- 
ing applications. (Ja.) 

Tr. Iodine: — Alone or with equal parts of glycer- 
ine, painted on once or twice daily until a coating 
forms, is sometimes used, or it may be applied as fol- 
lows: 

Iodi, 

Potassa Iodidi, aa ^iv. 

Glycerini, 3i. (Pp.) 

Ol. Cadi: — With alcohol and green soap, equal 
parts ; rub in night and morning. (Pp.) 

Oleate of Mercury: — 10—25 per cent, ointment 
rubbed in daily is of value. (Pp.) 

Plasters of Resorcin, Ichthyol, Hydronaphthol and 
Mercury are effective ; the latter is especially recom- 
mended by Kaposi. 



LUPUS VULGARIS. 

(Tuberculosis Cutis.) 

External measures are absolutely essential in early 
cases. In the early stages stimulating applications 
used with a view of causing absorption are unsuc- 
cessful, and severer methods will have to be employed. 
Mild applications, such as oils, ointments and plas- 
ters, namely, olive oil, soft soap, simple ointment, 
salicylic and mercurial plaster, will often form use- 
ful adjuvants in reducing swelling and inflammation, 
macerating crusts and promoting the formation of 
smooth cicatrices. 



348 DIGEST OF EXTERNAL THERAPEUTICS. 

Local treatment is either by operative procedures 
or by the application of caustics. 

Erasion by Volkmann's spoon is the foremost 
surgical method, though not complete, inasmuch as 
small nodules may be left, which must be removed by 
other means. It is well adapted to large confluent 
nodules, with flabby base and depressed infiltrated 
tissue. (Kap.) 

Curettage: — The whole patch or patches may be 
scraped with the dermal curette, then Pyrogallic 
Ointment, 25-30 per cent., should be applied for ten 
days, and that in turn followed by Mercurial Plas- 
ter. The acid will cause free suppuration and destroy 
the cells left by the curette. A second or third appli- 
cation may be necessary. Individual nodules may 
be bored out with Morris's double screw instru- 
ment, or with Fox's dental burrs and hook, then 
pure Carbolic Acid is applied to the little excavation 
thus produced. (Ja.) 

Galvano-Cautery: — Has the disadvantage of burn- 
ing healthy as well as diseased tissue ; it is, however, 
serviceable in destroying recurrent nodules and those 
situated on the mucous membranes. (B. H.) It is 
preferred by some dermatologists for application 
after curettage. 

Linear Scarification: — Another valuable measure 
and effective in non-ulcerative forms. The parts are 
thoroughly cross-tracked, according to Yidal's 
method; if bleeding is profuse cold or hot compresses 
should be applied. A five-bladed lancet, constructed 
for the purpose, may be used for making the inci- 
sions. After scarification a caustic is applied, fol- 
lowed by antiseptic dressings. The operation may 
have to be repeated. 



LUPUS VULGARIS. 349 

Besnier's Method:— Employed with advantage. 
This consists in the use of electro-cautery knives 
of various shapes and sizes, employed with a view of 
reaching all varieties of deposits. (Vn.) 

Multiple Punctate Scarification: — Also advised. 
Yeiel's instrument or Pick's multiple scarificator 
may be used. The knives before use may be dipped 
in iodine, carbolic, or some other antiseptic. This 
procedure is of service especially for hypertrophic 
conditions; also for the hypertrophic scars which 
sometimes results from erosion. (B. H.) 

The scars which follow the use of the curette, and 
linear and punctate scarification are usually less 
marked than those which result from the cauteries. 

(pp.) 

Excision and Grafting, After Thiersch's Method: — 
Excision is available for patches of any size. Both 
the lupoid patch and the part from which the 
grafts are to be cut (preferably the thigh) should be 
thoroughly disinfected with soap and water, ether 
and carbolic acid the day before operation, and a 
pack of gauze soaked in a solution of carbolic acid 1— 
20 should be kept on the surface until the operation. 
The following points may be mentioned : 

1. The parts are thoroughly cleansed and every pre- 
caution susequently taken by the operator to prevent 
infection by the knife. 

2. Before operating a line of incision is marked out 
beyond the disease by means of sterilized aniline dye. 

3. Haemorrhage is carefully arrested before grafts 
are applied. 

4. Dress the surface with simple layers of dry 
sterile gauze fastened with collodion, and allow the 
dressing to remain four or five days ; second dressing 



350 DIGEST OF EXTERNAL THERAPEUTICS. 

should be applied similar to the first, then a derma- 
tol or iodoform ointment. 

5. Certain cases are unsuitable by reason of impli- 
cation of the nasal cavity, multiplicity of areas, or 
the extent of the disease. Two or three sittings, at 
intervals, may be employed with extensive cases. 
(T. 98.) 

Though surgical procedures have largely superseded 
the use of caustics, the latter are none the less of ser- 
vice ; yet it must be remembered that certain of these 
agents, namely, Vienna paste, zinc chloride, the pure 
stick, or Conquin's paste; lactic acid, and salicylic 
acid produce most unsightly scars. (B. H.) 

Caustic Potash: — When thorough and extensive de- 
struction of tissue is desired a stick wrapped in a 
cloth with the point protruding, should be forced 
down into the diseased foci ; the effect of the caustic 
goes beyond the point touched; dilute vinegar should 
be kept near at hand to check and neutralize its ac- 
tion and relieve the severe pain. (Yn.) 

Nitrate of Silver: — Is effective in some cases, and 
as it leaves no scars may be selected to use on the 
face; its action, however, is superficial. Papules and 
tubercles may be destroyed by boring with the solid 
stick, and patches may be mopped with a saturated 
solution. (Ck.) 

Liq. Antimonii Chlorati: — Regarded by Unna as su- 
perior to any other remedy. He employs it in two 
forms, and recommended the addition of salicylic 
acid, creosote, and cannabus Indica. 

For ordinary cases : 



Acid. Salicylici, 


grs. xv. 


Liq. Antimonii Chlorati , 


gtts. XV. 


Ext. Cannabis Ind., 


grs. xv. 


Creosoti Fagi, 


grs. xxx. 


Vaselini, 


3i grs. xv, 


Adipis Lanae, 


giiss. 



LUPUS VULGARIS. 351 

This is applied to all the nodules with a glass rod, and the whole 
lupus region is covered with a Zinc Oxide Plaster. The covering 
intensifies the action of the ointment by its impermeable covering, 
and protects the surrounding parts. 

In older cases, with scattered nodules and deep 
forms of the disease, a stronger ointment may be 
used, viz : 

Acid. Salicylici, 

Liq. ArJiimonii Chlorat., 

Ext. Cannabis Ind., 

Creosoti Fagi, aa grs. xxx. 

Vaselini, grs. xxx. 

Adipis Lanae, giiss. 

The dressings are changed every day or every second day, ac- 
cording to the amount of suppuration. After some weeks of this 
treatment the nodules ulcerate and then begin to heal over, often 
without further treatment; a smooth surface is left. In obstinate 
cases, when the dressing is changed, the Liquor Antimonii 
Chlorati may be applied to doubtful spots. Cocaine may be pre- 
viously applied. (T. 97.) 

Salicylic Acid and Creosote: — 1 part of the acid 
with 2 parts of creosote, made into a plaster, was 
regarded by Unna as the best superficial caustic, 
until his adoption of the preparation of chloride of 
antimony as above. (T. 97.) 

Hydrarg, Bichlorid.: — Unna recommends the fol- 
lowing: 

Hydrarg. Bichlorid., grs. iii. 

Acid. Carbolici, grs. xii. 

Alcohol. , 3 i. 

A small sharpened stick is dipped into this solution and bored 
into each little lupus deposit; The pain does not last long. 

Pyrogallic Acid: — Is one of the best remedies; an 
ointment of 31— %i of vaseline, spread on cloth and re- 
newed twice daily, is painless and efficient in many 
instances ; it appears to select the diseased tissues 
and acts but little on the healthy. (N.) 



352 DIGEST OF EXTERNAL THERAPEUTICS. 

A combination with Aristol is used, viz : 

Pyrogalol, grs. ix. 

Aristol, grs. xviii. 

Lanolin, 

Vaseline, aa ^ss. (T. 97.) 

Zinc Chlorid.:— According to the following for- 
mula: 

Zinc. Chlorid., 

Antimonii Terchlorid., aa ^ij. 

Acid. Hydrochloric, q. s. 

Enough acid is added to dissolve the Zinc, and the mixture is 
rubbed up in a mortar with enough Powdered Licorice to make a 
paste. This forms a powerful caustic, but it is very painful and eats 
through both healthy and diseased tissues. (Vn.) 

(For other caustic preparations of this remedy see 
Epithelioma.) 

E thylate of Sodium :— Applied on glass rods; the part 
should be first dried as far as possible, and no water 
allowed to touch it while the application is being 
made. This agent is less painful than other caustics, 
and may be preferred in lesser operations when an 
anaesthetic is not used. (N.) 

Cosme's Paste:— As modified by Hebra is as fol- 
lows : 

Acid. Arseniosi, 9i. 

Hydrarg. Sulphuret. Rubr., gi. 

Ung, Simplicis, ^i. 

Spread on lint or linen and apply firmly; leave it on for two or 
three days; poultices are then applied until the slough comes 
away; then mild stimulating ointments. This method is satisfac- 
tory but very painful. 

Lactic Acid: — Has given beneficial results; the pure 
acid is made into a paste with salicylic acid ; the lint 
saturated with the remedy or covered with a thin 
layer of the paste should be applied; the surrounding 



LUPUS VULGARIS. 353 

healthy tissue must be protected by gutta percha so- 
lution. After twenty-four hours remove and dust 
with antiseptic gauze. (Al.) 

At Unna's clinic, pointed matches are soaked in the 
following solution : 

Sublimate, i part. 

Salicylic Acid, 10 parts. 

Ether, 25 parts. 

Olive Oil, 100 parts. 

These are bored into each individual nodule, the ends cut off 
with scissors and left in situ; then covered with Mercury Carbolic 
plaster; after twenty-four hours this is removed, the part washed 
and the holes filled with the following powder: 

Sublimate, grs. iss. 

Cocaine, grs. viii. 

Salicylic Acid, grs. viii. 

Mag. Carb., ^iiss. (T. 96.) 

(For other caustic applications see Epithelioma.) 

Aristol: — Has been found effective after curettage. 

Ethyl-Diamine Cresol:— Has been favorably men- 
tioned; it is a colorless, nearly non-toxic liquid, with 
remarkable penetrating power, and a stronger disin- 
fectant than cresol. Solution of 1—5000—3000 on 
compresses have been found healing in lupus of the 
face. Continuous baths have been used for the dis- 
ease on the limbs. (T. 98.) 

Guaiacol and Thymol:— Have been successful sub- 
cutaneously. Injections of fifteen minims of the f ol- 
io wing twice a week : 

Thymol, gr. xxx. 

Guaicol (Sterilized), 

Olive Oil, aa gi gtts. xv. 

Great caution is necessary, as severe pulmonary 
congestion is apt to occur. (T. 96.) 
Salicylic Acid: — In addition to combination with 
24 



354 DIGEST OF EXTERNAL THERAPEUTICS. 

other remedies as already mentioned, is used in other 
forms; a 10—20 per cent, plaster, changed once or 
twice a day ; a saturated solution in collodion, said 
to be efficacious after cleansing the parts with an al- 
kaline solution, or an ointment si-ii— gi as a mild 
and slow acting remedy. 

Picric Acid: — Thoroughly dusted on the parts, fol- 
lowed in a few days by 1—20 per cent, ointment, con- 
stitutes another method which has been reported 
successful. (T. 96.) 

Mono-Chlorophenol: — 20 per cent, solution in alco- 
hol rubbed in rather hard with a pad of wadding 
every two days for several months has been tried 
with encouraging results. (T. 98.) 

Injections of Calomel and of Camphorated Naph- 
thol have also been recently employed. (T. 98.) 

Meragliano's Serum: — Two cases have been re- 
ported as successfully treated ; doses of 16 and 80 
minims alternately, the part being painted with the 
serum. (T. 97.) 

Tuberculin: — Hopes that have been raised in re- 
gard to the use of this remedy have been proved to 
lack foundation, as the disease was found to recur 
after the injections had been discontinued and in 
some cases with increased virulence. 

Koch, after nearly five years silence, has announced 
three new modifications of tuberculin, including that 
of tuberculin R. with immunizing and curative proper- 
ties, which has led to marked improvement, by injec- 
tion, in lupus vulgaris. Koch's directions were to 
commence with a small dose (one five-hundredths of 
a milligramme) which is raised as rapidly as possi- 
ble, caution being exercised not to excite constitu- 
tional reaction and not to administer a second dose 



MALIGNANT PUSTULE — ANTHRAX. 355 

until the temperature has fallen to normal or nearly 
so. "The cure is completed when a twenty milli- 
gramme dose is reached." 

The remedy has been employed by Maragliano, Bus- 
senius, Worner, Sceligmann, Malcolm, Morris, Whit- 
field, Lassar, Doutrelepont, and Van Horn with gen- 
erally favorable results, but judging from the reports 
there were no decided cures. Doutrelepont recom- 
mends that the dose be increased more slowly than 
suggested by Koch. In brief, it may be said that the 
use of tuberculin for tuberculosis of the skin has 
scarcely yet gone beyond the stage of experimenta- 
tion. The preparations, too, are not of uniform 
strength and may sometimes cause unfavorable 
symptoms. The difficulty of obtaining it and the 
price are additional drawbacks to its practical use. 



LUMBAGO. 

(See Muscular Rheumatism.) 

MALIGNANT PUSTULE (ANTHRAX.) 

As soon as recognized thoroughly, Excise and 
Cauterize the raw, exposed surface with the Galvano- 
Cautery, pure Carbolic Acid. Nitric Acid, or Caustic 
Potash; applications like Iodine, etc., are absolutely 
useless. (Gn.) 

Carbolic Acid: — Subcutaneous injections several 
times daily of a solution (about 2 per cent.), a little 
distance from the seat of the lesion has proved effect- 
ive in preventing the brawny oedema. To prevent 



356 DIGEST OF EXTERNAL THERAPEUTICS. 

extension, the neighboring parts may be bathed with 
a 10 per cent, solution in oil of glycerine. (An.) 

After removal of foci by the actual cautery, inject 
hydrogen peroxide and apply compresses of carbolic 
acid solution 1-50. (Sj.) 

Injections of a solution of one part of carbolic acid 
to five of glycerine are also advised, administering 
20-30 minims around the sloughing tissues, but not 
into the same ; the needle should be introduced about 
one inch, and withdrawn slowly while pressing out 
the solution; the surface should then be dressed with 
carbolic fomentations 1-40, which should be con- 
tinued until the slough separates. (Sj.) 

Iodine Injection: — A 10 per cent, solution or the 
pure iodine are recommended in conjunction with the 
therm o-cautery. (T. 98.) 

Deep Crucial Incisions: — Followed by the applica- 
tion to the bottom of the incisions of Carbolic Acid 
1-20, or Bichloride of Mercury 4-15 per cent, mixed 
with calomel, constitute another method ; as the so- 
lution dissolves, it deepens the cauterization. (Ty.) 



MEASLES. 

Sponging: — For hyperpyrexia, sponging with water 
at 90°-95° may be employed, or if this is ineffectual 
a temperature of 80° may be advantageously substi- 
tuted. As a last resort cold water baths may be em- 
ployed. (Strr.) 

Cold Baths and Cold Pack: — When there is high 
temperature with nervous symptoms nothing is so 
reliable. The temperature of the bath should be at 
first 100°, then gradually lowered to 85° or 80° ; the 



MEASLES. 357 

body should be rubbed briskly while in the bath, and 
water applied to the head. After removal, dry 
quickly and wrap the patient in a blanket. The bath 
should last from five to twenty minutes. The cold 
pack may be applied as follows: Strip the patient 
and envelope him in a sheet which has been wrung 
out in water at the temperature of 100° ; upon the 
outside of the sheet rub on ice over the entire trunk, 
first anteriorly then posteriorly, continue this for five 
minutes or more, according to indications ; after- 
wards roll the patient in a blanket without the re- 
moval of the pack. The head should be sponged with 
cold water, and hot baths if necessary should be ap- 
plied it to the feet. (Hit.) 

Hot Baths: — These are indicated when there is high 
temperature, feeble pulse and cyanosis, conditions 
which contra-indicate cold baths or cold packs. 
Mustard may be added, ice should be applied to the 
head during the bath. (Hit.) 

Hot Mustard Baths:— At a temperature of 100, 
half an ounce of mustard to the gallon, are indicated 
in malignant types, the patient should be immersed 
up to the neck for about three minutes, removed 
quickly, dried and placed between blankets, or 
wrapped in blankets and dried later. Then baths 
may be administered every two hours. (Strr.) 

Hot Pack: — With hot water or mustard water, 2 
drachms to the gallon, may be used with the same 
indications mentioned for hot baths. They may be 
renewed every half hour. (Strr.) 

Simple washes of Borax, grs. x-^i, or Hot Water 
may sometimes be necessary for the eyes, and 
Dobell's Solution for cleansing the throat. (Strr.) 

The discovery of the presence of pneumococci 



358 DIGEST OF EXTERNAL THERAPEUTICS. 

in the buccal secretions during the course of the 
disease would seem to point to disinfection of the 
mouth. (Hit. ) 



MENINGITIS, ACUTE CEREBRAL. 

(Lepto- Meningitis.) 

Extreme quiet and avoidance of all disturbing in- 
fluences is of the utmost importance; a darkened 
room is advisable. 

Ice Bag: — Should be kept on the head, and Leeches 
may be applied with benefit to the back of the neck 
and temples. (Ty.) 

Blisters: — Applied to the back of the neck are useful, 
and it is claimed not as painful as appearances would 
indicate. (St.) 

Mercurial Inunctious: — Are recommended when 
the disease is non-tubercular. (Ty.) 

Cold Sponging: — Useful to relieve fever. (An.) 

Surgical Interference should be resorted to 
promptly when there is disease of the middle ear. 



MENINGITIS, CEREBROSPINAL. 

Hot Baths: — Have been used successfully; the pa- 
tient receiving twelve baths at a temperature of 
104° in three days. (Sj.) Warm baths are highly 
beneficial in lessening the tendency to spasms. 

Aspiration of Cerebro-Spinal Fluid: — In many 
cases a favorable course has been ascribed to punct- 
ure. A simple Dieulafoy needle may be used, or a 



MENORRHAGIA AND METRORRHAGIA. 359 

Pavaz syringe; puncture is made between the laminae 
of the lumbar vertebrae a little to one side of the me- 
dian line. (Sj.) 

Cold:— Is generally advised; baths are both grate- 
ful and valuable ; ice bag to the head and long ice 
bag to the spine. (Bt.) 

Chloral Hydrate: — In 1 drachm doses by the rec- 
tum should be administered to an adult for the con- 
vulsions. No other remedy, sa3 r s Tyson, equals it. 

Chloroform or Ether: — Inhalations may be indi- 
cated in desperate cases. (Ty.) 

Morphine: — Hypodermically affords relief to the in- 
tense headache, myalgia, muscular contraction and 
tones the heart. (An.) 



MENORRHAGIA AND METROR- 
RHAGIA. 

As a rule, external treatment is unnecessary for 
menorrhagia, but when internal remedies alone have 
failed, they should be supplemented by these meas- 
ures. In such cases an examination should be made 
without delay. 

Rests is an important factor and should always 
constitute part of the treatment. (D.) 

Cold: — Cloths wrung out in cold water, or better, 
ice bags to the hypogastrium, or small rectal injec- 
tions of quite cold water. (K. C.) Cold sitz bath 
with the feet in hot water. (Rd. ) 

Heat:— A hot water bag applied at the junction 
of the dorsal and lumbar regions reduces congestion, 
and controls metrorrhagia and menorrhagia. (F.) 



360 DIGEST OF EXTERNAL THERAPEUTICS. 

Vaginal douches of water at a temperature of 125°— 
135° ma}^ be used in bad cases. (K. C.) 

Hydrastine: — Is indicated for haemorrhage due to 
metritis, endometritis, myomata, or incomplete in- 
volution ; a 10 per cent, solution, hypodermically, 
acts favorably. (K. C.) 

Astringent Injections:— Small injections of this na- 
ture are useful, such as Alum, ^ss-Oij., or a solution 
of Tannin; the latter is liable to stain the clothing. 
(D.) 

Tepid Hip Baths:— Are advised by Baruch, who 
claims they are superior to any internal medicine. 
The patient is to be placed in a hip bath at a tempera- 
ture of 85°, in which she is to remain from five to 
eight minutes ; constant friction is to be applied, fol- 
lowed by affusion, or preferably the circular baths; 
this douche at a lower temperature. (S. B.) 

Puncture of Cervix: — Followed by the application 
of tampons of boroglyceride is sometimes effective 
in cases of chronic congestion. (Alb.) 

Antipyrin and Salol: — Equal parts heated in a test 
tube ; a brown liquid is obtained which may be ap- 
plied with absorbent cotton to the whole endome- 
trium; it is said to be painless and productive of ex- 
cellent results. (Sj.) 

Cotarnine Hydrochlorate (Stypticin): — Is a very 
useful remedy ; when haemorrhage is very profuse in- 
ject 30 drops of a sterilized solution into the gluteal 
muscles. (Sj.) This drug is said to be superior to 
ergot or hydrastis, and is indicated when there is 
subinvolution, fungus, endometritis, haemorrhage 
from fibroids, and at the climacteric. 

Conium: — Suppositories of 2-4 grains with glycer- 
ine 1 part, gelatin 4 parts, introduced twice daily, 



MILIARIA — PRICKLY HEAT. 361 

form an excellent anodyne when the condition is as- 
sociated with ovarian disease. (F.) 

Salicylic Acid: — In cases not dependent upon some 
gross lesion, tampons moistened with a solution are 
valuable. (F.) 

Hot Saline Enemata: — Used with much benefit when 
the patient is faint from the loss of blood ; it will 
also tend to stop the flow. (D.) 

Tamponing: — When haemorrhage is severe, or in 
cases when it is not practical to see the patient 
often, use hot douches, then pack the vagina with 
tampons, allowing them to remain twenty-four 
hours ; those in contact with the cervix may be sat- 
urated with glycerite of alum. If this measure fails, 
the cervix must be dilated, and the whole uterine 
cavity packed. (K. C.) 



MILIARIA (PRICKLY HEAT.) 

Cold Baths or Sponging frequently in warm 
weather, light, loose clothing and light bed clothing. 
(Bt.) 

Soothing and Astringent Lotion, as mentioned un- 
der acute eczema, may be employed. 

Mild and Astringent powders as Zinc Oxide, Bis- 
muth Subnitrate, Starch, Lycopodium, Kaolin, 
Camphor Powder. (Ja.) 

Lemon Juice has a soothing effect in allaying irri- 
tation. (Al.) 

Borax or Boracic Acid may be added to sponge 
bath. (Bt.) 

Oil of Peppermint in Cosmoline recommended 



362 DIGEST OF EXTERNAL THERAPEUTICS. 

(Bt.), but ointments as a rule are not to be com- 
mended. 

Copper Sulphate:— 10 grs.-gi, much used in the 
West Indies. (Yn.) 



MILIUM. 

Remove the little pearl-like deposit by squeezing, 
and apply a drop of Iodine or Carbolic Acid; or touch 
with Nitrate of Silver (Vn.); or the skin may be 
washed with Soap Bark water and gently rubbed. 
(Kp.) 



MOLES. 

(See Naevus Pigmentosus.) 

MUCOUS PATCHES. 

Cleanliness is of paramount importance; the teeth 
should be cleansed at least twice daily with some an- 
tiseptic mouth wash ; for this purpose solutions of 
Boracic Acid, Borax, Myrrh, Chlorate of Potash, 
Soda Bicarb, are useful. The same solutions may be 
also employed as gargles and sprays for the pharynx. 

The following is one of the best combinations for 
this purpose : 

Sod. Borat., giii. 

Tr. Catechu., ^ss. 

Tr. Myrrh., ^ ss. 

Aquae, j§ vii. 



N^EVUS PIGMENTOSUS— MOLES. 363 

Dobell's solution, solutions of Alum and Hamame- 
lis also beneficial. (CI.) 
Another useful formula is : 

Tr. Myrrh., - gss. 

Potass. Chlor., ^iii. 

Aquae, q. s. ad. ^vi. (Sn.) 

Nitrate of Silver: — Is of great value. A few appli- 
cations of the solid stick or a solution, varying 
from 5—20 grains to the ounce, will frequently cause 
rapid healing. Lesions of the nasal mucous mem- 
branes may be treated by sprays of 5-10 grains. 
(B. H.) 

Glycero-Iodine (Iodine, grs. x-glycerine, |i) : — 
Gives quicker results than the acid nitrate of mer- 
cury. (CI.) 

Potass. Chlorat.: — 20 grains to the ounce, is recom- 
mended as a mouth wash to be used as a preven- 
tive. (Al.) 

Sulphite of Soda: — 1 drachm to the ounce. (Al.) 

When patches are not located on the mouth, wash 
with a solution of Bichloride of Mercury 1-2000, 
then dust with equal parts of Calomel and Subni- 
trate of Bismuth. (Sn.) 



N^VUS PIGMENTOSUS (MOLES). 

Caustics: — Are the best remedies for applying to 
small moles ; Nitric or Acetic Acids should be pre- 
ferred, the surface being touched with these agents. 

Electrolysis: — Is adopted for the removal of hairy 
growths and large moles. (Mor.) 

Removal by Excision:— All large moles will require 



364 DIGEST OF EXTERNAL THERAPEUTICS. 

an operation for their removal ; small ones may be 
removed by an elliptical incision. 

If there is any tendency to inflammation or malig- 
nant proliferation, immediate removal by the knife 
is demanded. The employment of caustics and irri- 
tants under these conditions is harmful. (W.) 

All methods of removal, it must be remembered, 
will have a slight scar. 



N^EVUS VASCULARIS. 

Early treatment is generally advisable for the cap- 
illary variety and small growths. 

The methods of treatment consist of Excision and 
Caustics for port wine marks, Scarification and 
Electrolysis for venous naevi, and Excision; in the 
latter instance, when the size and location contra-in- 
dicate, Ligation may be substituted. 

Electrolysis: — Is the best method for the majority 
of these growths. In the capillary variety, and in 
port wine marks, it is best to apply by making multi- 
ple punctures in parallel lines perpendicularly to the 
skin and entirely through it. By this method it is 
possible to destroy small naevi and to diminish the 
disfigurement of port wine marks. A scar will be left, 
but it is much less conspicuous than the naevus. The 
use of a single needle scars less than a group ; the 
punctures should be made at least a sixteenth of an 
inch apart. Applications must be repeated until the 
naevus is destroyed ; the entire point should be gone 
over at each application. An interval of two weeks 
should elapse between each treatment. (Ja.) 

Parenchymatous Injections: — Various agents have 



N^EVUS VASCULARIS. 365 

been used, viz: Carbolic Acid, 2 per cent, solution, in- 
jections of 5—10 minims as in carbuncle; Tr. Chloride 
of Iron, Tr. Cantharides recommended by some, but 
there is danger of producing embolism unless it is pos- 
sible to isolate the growth. 

Alcohol: — 5-7 minims of a 95 per cent, solution ; 
the naevus should be encircled by a ring on which 
pressure is made to arrest the circulation, and the 
point of the syringe slowly withdrawn during injec- 
tion. The tumor will gradually solidify. Injections 
may be repeated at intervals of several weeks, until 
disappearance of the growth is effected. (Al.) 

Carbolic Acid "Tattooing" : — A method so termed 
is said to give excellent results, leaving little or no 
scarring. It consists of puncturing the affected area, 
a portion at a time, with a number of small fine 
needles bound together; these are first dipped in a 50 
per cent, or stronger solution of carbolic acid. The 
surface should be prepared by washing with alcohol. 
After application collodion is freely applied for pres- 
sure and protection. (F.) 

Ligation: — Suited to some forms of vascular 
growths, though electrolysis is generally preferred ; 
venous naevi too large to permit of excision may be 
ligated. (T. 97.) 

Linear Scarification: — As employed in acne rosacea, 
to which the reader is referred, gives good results in 
small nasvi and telangiectasis ; it is not suitable for 
larger growths. 

Excision: — With subsequent transplantation by the 
method of Shiersch, is the only reliable remedy, but 
belongs to the domain of surgery. 

Nitric Acid, Glacial Acetic Acid, Trichloracetic 
Acid, Monochloralitic Acid are also used as cauter- 
ants, but are uncertain in their effects. 



366 DIGEST OF EXTERNAL THERAPEUTICS. 

Collodion: — Employed on account of its contractia 
power. It is employed for capillary naevi in children 
and as a base combined with active agents, viz 
Bichloride of Mercury, Collodion (grs. viii— %i), :, 
caustic useful for small nasvi, a circle of pure collo- 
dion should first be applied around the naevus, to 
protect the bealtlry integument ; a single applicaitou 
is usually sufficient ; a dry ischar follows which sep- 
arates in a few days. (Al.) Salicylic Acid and 
Lactic Acid, 10 parts of each, with collodion 80 
parts, is also used for small growths. (F.) 

Creosote: — More or less diluted, applied two or 
three times a day, is said to give excellent results. 
Excoriation and ulceration is at first produced, which 
is finally followed by healing. (F.) 

Chromic Acid: — Punctures with needles dipped into 
a 50 per cent, solution have been followed with suc- 
cess. (Kp.) 

Sodium Ethylate: — Is one of the best caustics, 
causes little pain, should be applied on the end of a 
glass rod. To avoid scarring, only a small part of 
the naevus should be treated at one time. A crust will 
form which should be left undisturbed. (Kp.) 



NASAL POLYPUS. 

Destructive in situ by injection of such agents as 
Chromic Acid, Tincture of Iodine, or Tannic Acid, 
3i-|i, may be successful, but it results in a necrotic 
mass which remains in the nasal cavity as an offen- 
sive body until it sloughs away. When the polypi 
are numerous, this treatment is obviously distressing. 
(Bos.) The best method, therefore, for the removal 



NASOPHARYNGEAL CATARRH— CHRONIC. 367 

of these growths is by the Wire Snare. Removal by 
forceps, formerly much practiced and still used, to 
some extent, is condemned. (Bn.) After removal the 
pedicle may be touched with the galvano-cautery. 

Sodium Ethylate: — Saturate a bit of cotton with 
the drug and apply two or three minutes ; then 
withdraw; the mass of polypi will be almost imme- 
diately destroyed. Touch the base with the same. 
The application causes slight burning pain and occa- 
sionally moderate haemorrhage. (Al.) 

Tannic Acid: — In the small vesicular variety, and 
in case, where the growth is soft and small, there is 
every prospect of temporary, if not permanent relief, 
by application of the fine powder two or three times 
a day. (Wt.) 



NASOPHARYNGEAL CATARRH- 
CHRONIC. 

(See Chronic Rhinitis.) 

Local treatment is similar to that of chronic rhini- 
tis, to which the reader is referred ; little, therefore, 
can be added. 

Important exceptions are the use of the post-nasal 
syringe for cleansing purposes, and the applications 
of sprays through the mouth. Muco-purulent dis- 
charges should be removed twice daily by washes and 
douches. 

The following will prove satisfactory for this pur- 
pose, having a tendency to control all proliferations 
as well as to dislodge the mucus : 



368 DIGEST OF EXTERNAL THERAPEUTICS. 

Acid. Carbolici, grs. iii. 

Potass. Chlorati, gi. 

Glycerini, gi. 

Aquae, ad. q. s. §vi. 

Or, 

Zinc. Sulpho-carbolat. , grs. iii. 

Acid. Salicylici, ^i. 

Aquae, %vi. (Bos.) 

Sodium Bicarb.:— A solution of 10 grains to the 
ounce (Iv.), or the following are useful for cleansing 
purposes : 

Sodii Bicarbonatis, 
Sodii Biboratis, 

Sodii Chloratis, aa grs. i. 

Sac. Alb., grs. xxxvj. 

Dissolve in wineglassful full of hot water. 

Another useful formula is the following : 

J-Naphthol., grs. xlv. 

Alcohol, ^x. 

One teaspoonful to a quart of boiled water. (T. 98.) 

After cleansing, the following will also be found of 
service : 

Gallic Acid: — By insufflation in the proportion of 1 
grain to 2 of gum acacia forms, according to Ivins, 
a most grateful and beneficial application : 

Iodine, grs. x. 

Glycerine, ^ i. 

Or, 

Zinc. Chlorid., grs. x. 

Water, !§i. (Iv.) 

To effect a cure, radical measures and strong appli- 
cations are necessary according to Bosworth, who 
recommends the following : 

Tr. Iodine, Glycerole of Tannin, or Nitrate of Sil- 
ver (grs. xx— xxx— ^i), application to be made at in- 
tervals of three days or a week. Also Lactic Acid, 



NEURALGIA. 369 

3ss— ^i-Eh or Monochloracetic Acid, undiluted for the 
hypertrophies. In making these strong applications 
great care should be taken not to touch the palate. 

Chromic Acid may be applied with good effect to 
the broad, flat, thickened condition of the glandular 
structure of the pharynx. 

Galvano- Cautery: — May be employed when other 
measures have failed for the reduction of the hyper- 
trophy and stitching. 



NEURALGIA. 

Dry Heat: — One of the best palliatives during par- 
oxysms ; may be applied by means of hot water bag, 
hot hop bag, or Japanese fire box. (Gn.) 

Aconite: — Is useful, especially in neuralgia of the 
fifth pair (R.) ; may be applied as an ointment, or 
the tincture may be painted on the affected area. It 
also enters into the formation of various liniments, 
viz: 

Tr. of Aconite, 31. 

Essential Oil of Mustard, gi. 

Glycerine, ^ i. 

Rectified Spirits, ^vi. 

Rub in about two teaspoonfuls on affected part night and morn- 
ing. 

The following is said to be still more efficacious : 

Tr. of Aconite, gi. 

Camphor, ^ii. 

Chloroform, ^ii. 

Oil of Cajuput, ^ii 

Tr. of Capsicum, ^ii. 
Rect. Spts., to %vi. 
Scent with oil of origanum. (T. 98.) 
25 



370 DIGEST OF EXTERNAL THERAPEUTICS. 

Aconitia: — In the form of an ointment (2 grains to 
the drachm), or a 2 per cent, solution of the oleate in 
oil, will afford marked relief. Its local use being not 
free from danger, caution must be exercised and 
never apply over denuded surfaces. (F.) 

The following is Ludlow's formula, which is rec- 
ommended for " any local pain ; " a portion the size 
of a pea is to be rubbed in over the affected part. It 
is also serviceable in inflammation of joints : 

Aconitinse, grs. iss. 

Atropinae Sulph., grs. ss. 

01. Tiglii., Mii. 

Petrolati, gi. (Sm.) 

Anodyne Colloid: — The following mixture is highly 
recommended ; it forms a collodion which is brushed 
over painful parts five or six times, forming successive 
films. Absorption of the alkaloid may be facilitated, 
if desired, by covering with spongo-piline : 

Amyl Hydrat., 

Collodion (B. P.), aa £i. 
Aconitine, gr. i. 

Veratrine, grs. vi. (T. 97.) 

Apone: — A preparation specially so-called is made 
as follows : Capsicum, ^viss ; aq. ammonia, ^iij gii ; 
thymol, chloral hydrat., aa giiss ; alcohol, Oij ; the 
capsicum is macerated for a month in the alcohol 
and ammonia mixed; it is then expressed and the 
thymol and chloral added. The preparation is then 
painted on the skin pure or diluted. (F.) 

Belladonna: — This extract thinned with glycerine, 
and painted on, is effective (Ty.) ; the liniment and 
ointment is especially recommended in intercostal 
and facial forms. (R.) 

Capsicum: — Is used in a strong infusion which is 



NEURALGIA. 371 

applied on lint and covered with gutta percha. (R.) 

A plaster may be made by incorporating the tinct- 
ure with gum arabic and spreading the mixture on 
paper. (F.) 

Chloral Camphor (equal parts triturated ) : — Is some- 
times useful. Morphia may be added with advant- 
age. (B.) 

Counter- Irritation: — Will often afford relief, sina- 
pisms, an ammonia rubefacient, and in some cases a 
cantharides blister may be applied with benefit over 
the affected nerve. (Al.) The latter, though often of 
service, has, however, been superseded by more 
modern and less disagreeable measures. 

Chloroform: — A deep injection of from 10—15 
minims in the neighborhood of an affected nerve has 
been found extremely valuable. Rarely does any lo- 
cal trouble ensue from its use except temporary in- 
duration. Long-standing neuralgias of the super- 
ficial division of the fifth pain have been relieved. 
Tyson says spirits of chloroform should be used. 
This remedy must be employed cautiously, as it may 
cause sloughing. The same writer recommends it 
more especially for sciatica. It also enters into the 
formation of various anodyne liniments ; a useful one 
is as follows: Chloroform, tr. aconite, aa ^ss; lin. 
saponis, gi. Moisten a bit of flannel and apply cover- 
ing with oiled silk. 

The following form effective counter-irritant lini- 
ments : 

Chloroform, 

01. Terebinth., aa ^i. 

Lin. Sapon., ^ii. 

Or, 

Chloroform, 

Lin. Camphor., aa ^i. (B.) 



372 DIGEST OF EXTERNAL THERAPEUTICS. 

Cocaine: — Might be expected to constitute a useful 
palliative, but in order to obtain action through the 
skin it must be only employed in ointments or solu- 
tions in the strength of 10—15 per cent. A 20 per 
cent, solution dissolved in oil of cloves, 5-10 minims 
being rubbed in with the finger over the seat of pain 
is recommended. Strong solutions must be used 
with caution on mucous surfaces. The hypodermic 
use is more effective ; the dose is V^ gr. The danger 
of forming the cocaine habit must always be taken 
into consideration. (Ty.) 

Guaiacol: — Compresses wet with 15 drops to 1 
drachm and placed over the part are reported to 
afford almost instant relief. The drug should be 
pure and left in contact with the skin only a short 
time, otherwise absorption may occur and which may 
produce fall of temperature and symptoms of collapse. 

The following solution is to be painted on two or 
three times a day, covering the part afterwards with 
cotton: 

Menthol, 

Guaiacol, aa grs. xv. 

Absolute Alcohol, ^ v. 

Use little less than a drachm. {T. 97. ) 

Ether: — In 15 drop doses, subcutaneously, or mixed 
with alcohol and injected as near as possible to the 
seat of pain, has been successful in rheumatic neu- 
ralgias, sciatica and torticollis. (Sm.) 

Essential Oils: — Have the power to relieve the 
pain of sensory nerves, especially the oil of cloves, a 
solution of which in rhigoline is a nostrum for super- 
ficial neuralgia. 

The following combination may be employed : 



NEURALGIA. 373 

01. Caryophylli, 
Ol. Gaultherise, 

Ol. Thymi, aa gi. 

Tr. Benzoini, 

Tr. Cinnamomi, aa % iv. 

Apply on lint and cover with oiled silk. (B. ) 

Methyl Chloride: — Is an effective analgesic in the 
form of a spray. Employed in this manner it is often 
very satisfactory in many forms of neuralgia. A 
large percentage of cures has been reported. (B.) 

Morphine: — By hypodermic injection affords relief 
in all forms, but should only be employed as a last re- 
sort because of the danger of forming the habit. 
(Gn.) This is especially true in chronic forms. 

Mud Baths:— Such as those of St. Armand, Schwal- 
bach and Franzenbad are of great benefit in chronic 
forms dependent upon debility, neurasthenia and hys- 
teria. (Ty.) 

Osmic Acid: — The 1 per cent, solution in water and 
glycerine has been used with good effect by hypoder- 
mic injection over the course of the nerve in sciatica. 
(Ty.) 

Peppermint Oil: — An old remedy. May be painted 
along the course of the nerve, or applied with cot- 
ton, often with good effect. (Sm.) Combined as 
follows, it has been found of great service in neural- 
gic and other forms of headache: 



Oil of Peppermint, 


5 parts. 


Essential Oil of Mustard, 


i part. 


Camphor, 


2 parts. 


Ether, 


io parts. 


Rectified Spirit, 


30 parts. 


Apply with a camel's hair brush. 


(T 



97.) 

Veratria: — In the following formulae; a small quan. 
tity is rubbed in over the seat of pain : 



374 DIGEST OF EXTERNAL THERAPEUTICS. 



Veratrine, 2 parts. 

Oleic Acid, 98 parts. 



Or, 



Veratrine, 4 parts. 

Alcohol, 6 parts. 

Benzoated Lard, 98 parts. (H.) 

Actual Cautery: — This may be used to great ad- 
vantage in the treatment of long-standing cases, espe- 
cially of the larger nerve trunks, when other meas- 
ures have failed. 

The probable occurrence of scars must be taken into 
consideration. (F.) 

Strychnine: — Subcutaneously, in full doses, is of 
benefit when impaired nutrition is the cause. (Ty.) 

Electricity: — Preferably in the form of galvanism, 
is valuable in many cases ; the positive current over 
sensitive points, negative over spine at supposed ori- 
gin of irritation. The strength will vary from 5— 35 
milliamperes, according to the susceptibility of the 
affected part. (Gn.) While the constant current is 
most frequently employed, faradism may also be 
used. Experience has shown that the direction of the 
current may be ignored, though it is commonly rec- 
ommended to place the positive pole over the painful 
part. A sedative effect is best obtained by a weak 
galvanic current, just enough to produce a trembling 
sensation. (H.) 

The application of drugs by electricity has been 
successfully employed, the drug in solution being ap- 
plied with the positive pole with a specially con- 
structed electrode. Cocaine (10 per cent, solution) 
will give relief which will last about eleven hours. 
10—15 milliamperes should be used for from five to 
fifteen minutes. Morphine may be administered in 
the same way. (H.) 



NEURASTHENIA. 375 

Acupuncture and Aqua Puncture: — Are measures 
which are of service, the latter often remarkably 
beneficial. (B.) 

Excision: — Has been used as a last resource, with 
success and failure. (Ty.) 



NEURASTHENIA. 

The measures recommended for hysteria are equally 
applicable to this condition, especially Wier Mitchell's 
"rest cure." (See Hysteria.) 



NIPPLES, FISSURED AND SORE. 

Wash the nipples before each nursing, and to 
harden them, apply daily Green Tea, Brandy, Al- 
cohol, Port Wine, Hamamelis, or Lime Water. 
(Bt.) 

For painting on the part after preliminary disin- 
fection the following protective preparations are 
efficacious : Collodion ; Gutta Percha (dissolved in 
Chloroform), which has the advantage of not be- 
ing soluble in the child's saliva; and Benzoin, which 
forms a protective varnish of great value. The lat- 
ter is also useful mixed with equal parts of glycerine. 
(Bt.) 

Glyceroles, or Lotions of Hydrastis, Calendulae, 
Arnica, Hamamelis, Phytolacca, and Borax are all 
used in the proportion of one drachm of the remedy 
to half an ounce of glycerine. 

Tannate of Glycerine; Cerates of Graphites, Car- 
bolic and Boracic Acids, Hamamelis, Hydrastis, 
Calendula, and Phytolacca. (Bt.) 



376 DIGEST OF EXTERNAL THERAPEUTICS. 

Nitrate of Silver: — The crayon touched to the nip- 
ple carefully and gently is sometimes very effective 
when the part is ulcerated. (Hpl.) Agnew advised 
the application of a 50 per cent, crayon to the bot- 
tom of the fissure in obstinate cases. The nipple 
should first be cleansed thoroughly and afterward 
washed with a little milk and water, a dressing of 
zinc oxide ointment is said to complete the cure. 

Nitrate of Lead: — As a cicatrizing astringent is 
very useful dissolved in glycerine or brandy in the 
proportion of grs. x-gi. It should be applied after 
nursing and the child should not be allowed to take 
the breast until the nipple has been thoroughly 
washed. (N.) 

Rhatany: — As an ointment or wash has been very 
successful. (Wa.) Use a watery solution of the ex- 
tract, or an ointment in the proportion of 1 part of 
the extract to 15 of cocoa butter. 

Iron: — An effective application is composed of 2 
drachms of the liq. ferri subsulphate with 6 drachms 
of glycerine. This is applied with a camel's hair 
brush. (B.) 

Cocaine: — 4 grs. with distilled .water 1 oz. may be 
applied, wash off thoroughly before nursing. (Sn.) 

Shields of rubber or zinc may be worn. 



NODES. 

Stramonium: — A leaf of the plant soaked in spirits 
and laid on the part will often act as a palliative. 
(Al.) 

Mercurial Plaster: — One of the best applications, 
especially for syphilitic varieties. (F.) 



ONYCHIA. 377 

Iodized Vasogen: — Will often prove effective after 
mercurial plasters fail to relieve. It should be ap- 
plied with caution several times a day. (F.) 

The following ointments will be found of service : 



Iodi, 








Terebinth. Canaden., 






aa £i. 


Collodii, 






I*v- 


Apply with a brush. 








Or, 








Morphiae, 






grs. viii 


Hydrarg. Oleat. (10 to 


20 per 


cent. ) 


Si- 


Apply with a brush. 








Or, 








Hydrarg. Biniodid., 






grs. vij. 


Potas. Iodidi, 






9i- 


Adipis, 






§i. 


Or, 








Cadmii Iodid., 






3i- 


Adipis Prseparat., 






3*- 


Ivin. Aconiti, 






3ii. 


ONYCHIA. 





(Sn.) 



Lead Nitrate: — Has cured cases. It should be thor- 
oughly sprinkled on the ulcerating surface. After a 
day or two the crust which forms is removed and the 
sore takes on a healthy action. Pain and fetor are 
diminished and resolution is sometimes complete in a 
week. (Hel.) 

When there is much pain the following : 



(Vn.) 



Hydrarg. Chlor. Mitis, 




Pulv. Opii, 




Ext. Belladonnas, 


aa grs. iii 


Ung. Aq. Rosse, 


%s&. 



378 DIGEST OF EXTERNAL THERAPEUTICS. 

Alum. Usta: — Is useful in the following wash : 

Alum. Ustse, grs. iii. 

Zinc. Sulphat., grs. ii. 

Plumb. Acetat., grs. ii. 

Aq. Destill., gi. (Al.) 

Resorcin: — 10—20 per cent, ointment or plaster 
will, it is claimed, often abort the disease if seen 
early. (Ja.) 

The pustules should be evacuated, cleansed with 
Carbolic Acid solutions, and dusted with antiseptic 
powders such as Europhen, Airol, Xanoform, etc. 

Removal of Matrix: — Is recommended for cure, 
cutting away the entire matrix ; simple evulsion will 
not answer. After removal dress with iodoform. 
(Hel.) 



OOPHORITIS. 

(See Pelvic Inflammation.) 

OPHTHALMIA NEONATORUM. 

In the first stage, strict cleanliness, constant re- 
moval of all secretions, and the use of antiseptic irri- 
gations are essential. No strong or irritating solu- 
tion should be applied at this period. In the second 
stage, and not until then, nitrate of silver is the sov- 
ereign remedy. If only one eye is affected the other 
should be protected. 

Antiseptic douches should be administered as pre- 
ventives to women with vaginal discharges just be- 
fore confinement. For this purpose solutions of 



OPHTHALMIA NEONATORUM. 379 

Bichloride of Mercury are recommended (Mac.) 
Crede advised as a preventive a 2 per cent, solution 
of Nitrate of Silver dropped into the eyes of newly- 
born infants. Other measures have also been ad- 
vised, with the same end in view, but none are as cer- 
tain in their effects as nitrate of silver. If the disease 
is of an entirely purulent character, active and ener- 
getic measures should at once be instituted, other- 
wise the infant will lose its eyesight. The indica- 
tions are essentially the same as those of purulent 
conjunctivitis in adults. 

The general line of treatment may be summarized 
as follows: 

1. During the earlier stages when inflammation and 
oedema of the lids is severe, in addition to strict 
cleanliness the constant application of cold should 
be maintained in the following manner: Take square 
compresses of lint, lay them upon a block of ice, then 
when cold, place them on the swollen lids. Change 
the compresses as frequently as it is needful to keep 
up a continuous uniform impression. 

2. The discharge should be constantly removed ; 
to accomplish this proceed as follows : Gently sepa- 
rate the lids ; wipe away the tenacious secretion with 
bits of moistened absorbent cotton and irrigate the 
conjunctival sac freely with an antispetic solution. 
Care should be observed not to permit the point of 
the pipette to come in contact with the cornea. A 
saturated solution of boracic acid or bichloride of 
mercury in solution not greater than 1 grain to the 
pint may be used for irrigation; the former is the 
more useful. (T. 96.) 

Nitrate of Silver: — As soon as the discharge becomes 
free and creamy the remedy should be applied as fol- 



380 DIGEST OF EXTERNAL THERAPEUTICS. 

lows : Carefully evert lids and secure exposure of the 
inflamed tarsal cartilage. Remove all discharge of 
lymph by irrigation ; wipe away all adherent parti- 
cles with moistened cotton and carefully touch the 
areas thus prepared with a solution of 10—20 grains 
to "the ounce by means of a cotton mop. Neutralize 
the excess with a solution of common salt 15-20 
grains to a cup of water. Continue applying the 
salt solution until a clear red surface is obtained; 
then return lids to position. The cornea should be 
carefully inspected before leaving. Finally apply 
pure vaseline to the lids, and introduce some within 
the conjunctival sac. 

4. Eserine: — A solution of -|— \ gr.-^i, one drop 
three or four times a day according to severity of 
case, should be used if the cornea becomes hazy or a 
small ulcer forms at the border; also Atropine Solu- 
tion (4 grains to §i), 2 drops may be instilled at 
night. Caution should be exercised lest constitu- 
tional effects of these drugs be obtained. If corneal 
haze continues, replace cold applications with hot, 
using carbolized water at 120°. (T. 96.) 

Potass. Permang.: — Flushing the conjunctival cul- 
de-sac with a solution of 1—5000 is recommended. 
A special laveur may be used and about 2 pints ap- 
plied in each eye twice a day. (T. 96.) 

Formalin: — In the strength of 1—1000-500 may be 
employed with great benefit as an antiseptic during 
the stage of corneal complication. When the ulcer is 
not large or is only beginning to appear, this treat- 
ment is strongly indicated. (N. O.) 

Mercury Oxycyanide: — This remedy, it is claimed, 
has antiseptic powers equal to those of the bichlor- 
ide, with the advantage of being less irritating and of 



ORCHITIS. 381 

possessing less power of coagulating albumen. So- 
lutions of 1-500 have proved effective. (T. 98.) 

Iodoform: — Finely powdered and dusted on the 
conjunctival sac after cleansing is employed ; may be 
applied at first even before cord is cut. (T.98.) 



ORCHITIS. 

Rest in bed and support of the parts as in epididi- 
mitis. 

Laudanum or Tobacco stupes, or both combined, 
are often helpful. A piece of flannel is wrung out in 
hot water, then dipped in the laudanum or a strong 
infusion of tobacco and wrapped around the testicle. 
A piece of oiled silk is placed over the stupe and the 
parts are wrapped in cotton and lightly bandaged. 
(B. H.) 

Carbolic Acid: — A 2 per cent, spray applied for fif- 
teen minutes daily is highly recommended. The 
parts are afterwards wrapped in cotton and sup- 
ported. This spray should not be used more fre- 
quently than the time mentioned for fear of causing 
excoriation of the skin. (CI.) 

Belladonna Ointment: — Spread on cloths and 
wrapped around the testicle is used to subdue pain. 
(B.H.) 

Guaiacol: — Applied to the groin and inner aspect of 
the thigh relieves pain and lowers temperature. (Sj.) 

Poultices: — Should be used with caution. In the 
beginning of the attack applied for a few hours they 
are of service. Long applied they increase engorge- 
ment and pain. (B. H.) Hop poultices are indicated 
both in specific and simple orchitis. (Al.) 



382 DIGEST OF EXTERNAL THERAPEUTICS. 

Ammonium Chloride: — Forms an excellent discuti- 
ent application in inflammatory swellings, and may 
be employed in this condition when applicable in the 
proportion of 1 drachm to 1 ounce each of rectified 
spirits and water. Cloths are moistened with the 
solution and frequently applied. (B.) 

Ice: — Is applied with the hope of aborting the in- 
flammation, and may be employed if the patient is 
seen at the onset of the attack. But its continued 
application is not desirable if the disease has pro- 
gressed to any extent, for the possibility of devitaliz- 
ing the parts and causing gangrene after effusion has 
occurred, must be taken into consideration. (Mor.) 

Puncture of the Tunica Albuginia: — Employed with 
gratifying results ; for the relief of pain and tension, 
it is very generally recommended. (Mor.) Complete 
antisepsis should be observed. 

Suspensory Bandages: — Should be worn after con- 
valescence. (Mor.) 



OTITIS, EXTERNA, CIRCUMSCRIPTA- 
FURUNCLE OF THE AUDI- 
TORY MEATUS. 

The following are useful for aborting the furuncle : 
Mercury (the Yellow Oxide), grs. ij— gi, or the Oleate, 
10 per cent., as ointments; Nitrate of Silver (the 
crayon application); and Menthol, 10-15 per cent, 
in oil. 

For a soothing effect, the following emollient oint- 
ments, painted on the wall of the meatus, are of ben- 
efit: Cold Cream, or Hydrarg. Ammoniat., grs. i— ij— 
§i of Ung. Aq. Rosse. (Bn.) 



OTITIS, EXTERNA, DIFFUSA. 383 

Also irrigations with hot water, to which Lauda- 
num may be added for the relief of pain. 

Other applications which may be employed are : 

Carbolic Acid and glycerine, 1-20. 

Burow's Liquid (see Appendix II.) 

Liq. Plumbi Subacetat Dilut., a few drops. 

Salicylic Acid in collodion, .^i— ^i. 

Tr. Iodine or Pure Glycerine painted on. 

Belladonna Ointment. 

When the furuncle has formed, it should be incised 
by Sexton's, Buck's or Politzer's knife. 

After incision the following washes may be used 
for irrigation, and for loosening crusts of discharge : 

Mercuric Bichloride, 1-10,000. 

Soda Bicarbonate, grs. x-xx— %i. 

Borax, grs. x-xx-^i. (Bl.) 



OTITIS, EXTERNA, DIFFUSA. 

Heat and Moisture: — Applicable to simple cases. 
Use an irrigating douche of hot water, or frequent 
instillation of hot water into the upturned ear. 
These may be repeated as often as the patient desires. 
Laurel water may be substituted for plain water. 

The following are useful instillations for the relief 
of pain : 

Morph. Sulph., grs. iv. 

Aquae, gii. 

Ten drops warm in the ear. 

Atrop. Sulph., gr. i. 

Aquae, §i. 

Five drops warm in the ear. 



384 DIGEST OF EXTERNAL THERAPEUTICS. 

Alcohol: — Pure, instilled into ear is said to abort 
inflammation and reduce swelling. (Bn.) 

Incision: — May be employed when other means 
have failed to check the inflammation. A careful ex- 
amination should be made with the mirror and the 
most inflamed spot located. The use of the probe 
for this purpose is contra-indicated. A bold incision, 
clear to the bone, is often followed by relief of pain 
and improvement. (Burnett.) 

Mild Syringing— With warm water (medicated), 
with carbolized soap, boric acid, borax, salt or bi- 
carbonate of soda, should be employed when the dis- 
charge is sero-sanguinolent, for then the canal is ex- 
ceedingly tender and intolerant of am^ irritant or 
stimulant. A cotton wool brush may be employed 
for cleansing; exercise care in its application, work- 
ing towards the outlet of the canal without undue 
pressure. (Bl.) 

Impalpable Powders or solutions of Alcohol are 
indicated when the discharge is sero-purulent, thick 
and irritating. Of the powders, the most effective 
are: Boric Acid; Borated Calendula; Salicylate of 
Chinoline (1 part with 16 of boric acid); Resorcin (1 
part boric acid, 8 parts); Boric Acid and Oxide of 
Zinc, equal parts. These should all be used spar- 
ingly. The most effective way in which to apply 
these powders is to insert an ordinary goose quill 
into one end of a flexible rubber tube the free end, of 
which is held in the mouth while the other is dipped 
into a saucer containing the powder, a little of 
which fills the quill, which is aimed at the desired 
part ; a slight puff from the mouth deposits the pow- 
der. 

The following liquid preparations are recom- 



OTITIS MEDIA. 385 

mended: 

Boric Acid, saturated solution. 

Zinc Sulphate, gr. i— Ji. 

Pyoktanin, 1-1000-2000. 

Solutions should be used warm and dropped in. 

Nitrate of Silver fused on the end of a silver probe 
or a solution on a cotton wool brush*, or Alcohol as 
strong as the patient can bear it are suitable agents 
for the reduction of redundant growths. (Bn.) 



OTITIS MEDIA. 

ACUTE CATARRHAL OTITIS MEDIA: 

Plantago: — A glycerole made of equal parts of the 
fluid extract from the fresh plant mixed with gly- 
cerine, equal parts of, distilled and filter. Five drops 
hot in the ear for the relief of pain and local inflam- 
mation. (Ho.) 

In the following combination, it is said, the drug 
scarcely ever fails to relieve : 

Fid. Ext. Plantago Maj., ^iv. 

Tr. Belladonnge, gtts. xv. 

Tr. Aconiti Rbd. , gtts. x. 

Sol. Morph. Sulph. (Magrudie), gtts. xx. 

Aq. Destill., q. s. ad. 5§i. 

Four or five drops warm in the ear at intervals of from ten min- 
utes to two hours. (Str. ) 

Another combination is the following : 

Fid. Ext. Plantago, ' ^i. 

Fid. Ext. Belladonnge, gtts. x. 

Glycerini 

Aq. Destill., aa giii. 

A few drops in the ear for pain. (Bl.) 

Morphia:— 5-10 minims of Majendie's Solution 
26 



386 DIGEST OF EXTERNAL THERAPEUTICS. 

may be dropped into the ear for the relief of pain, re- 
peating the doses every two hours, as indicated. (Bl.) 

Mullein Glycerole: — Take fresh flowers (old are in- 
ferior), digest in Jamaica rum ten days, express the 
extract, and use equal parts with glycerine and dis- 
tilled water. An excellent preparation with which to 
follow hydrogen peroxide, which should never be 
used alone. (Ho.) 

Atropia: — In the following combination may be 
dropped into ear for relief of pain: Atrop. sulph., 
grs. ii; acid, boraci, grs. x; aq., ^i. (Bn.) 

Cocaine Hydrochlorate: — 4 per cent, solution, a few 
drops in ear for relief of pain. 

Local Abstraction of Blood: — Is valuable in the 
first stages of both acute and purulent forms. 
Leeches are of great value in those cases attended 
with intense pain and when there is great hypere- 
mia, infiltration of parts and engorgement of the per- 
iosteum and mucous membrane. In many instances 
further progress of disease is arrested. Artificial 
leeches may be used and are decidedly preferable. 
(Dch.) 

Hot Douche: — Water poured into the meatus will 
frequently relieve pain at once when the artificial 
leech has failed; boric acid may be added, gss-Oj. 
(Bac.) Lucae's douche glass may be conveniently 
used. 

Nitrate of Silver: — Applied by a mop to the 
pharynx is of benefit when there is lryperaemia in 
that locality. The strength of the solution for chil- 
dren should be 10—15 grains to the ounce, for adults 
15-20 to the ounce. The Politzer may also be used 
occasionally. (Bck.) 

Steam: — Introduced into the ear is an excellent 



OTITIS MEDIA. 387 

method of applying heat; care must be exercised 
that it is not too hot. (Str.) 

Carbolized Glycerine:— 10-20 per cent, warm in- 
stillations are attended with good results. (T. 97.) 

Menthol Gauze: — Impregnated with 10-15 per 
cent, solution in oil, and inserted into the meatus for 
twenty -f our hours at a time, has been used with good 
results. (T. 97.) 

Inflation of the Ear Drum: — May be employed in 
less severe cases with slight hyperaemia, using the 
Politzer method or the catheter. The former should 
be constantly employed for the purpose of relieving 
accumulations of mucus and fluid, for the restora- 
tion of the drum to its proper position, and to pre- 
vent formation of adhesions. (Bn.) 

Paracentesis: — If in spite of treatment the mem- 
branum tympani is bulging with indications of per- 
foration, it should be punctured with the paracen- 
tesis needle and afterward douched with a solution 
of boric acid or bichloride of mercury, 1-4000. (Bl.) 

CHRONIC CATARRHAL OTITIS: 

As the majority of cases arise from lesions of the 
nose or vault, treatment should first be directed to 
those localities. (Bac.) 

The patient should be placed in the best hygienic 
surroundings, guarding against changes of tempera- 
ture and moisture as much as possible. 

Inflation and Catheterization: — When there is hy- 
pertrophy and hyperaemia of the eustachian tubes 
these measures are indicated, together with local 
treatment to the naso-pharynx. Bacon states that it 
is difficult to say how long the inflation treatment 
should be continued. In most cases nothing is 



388 DIGEST OF EXTERNAL THERAPEUTICS. 

gained beyond the third week, and on the other hand 
improvement may not begin until the fifth week. 

All manipulations should be made with the utmost 
gentleness. When the catheter is in position it 
should not cause pain. (Str.) 

The following are recommended for application to 
the pharyngeal surfaces: 

Nitrate of Silver, applications should be used to 
the vault of the pharynx as long as hyperaemia is 
recognizable to any degree. The influence of the 
remedy is not confined to the actual areas of applica- 
tion. (Bac.) 

Potass. Iodidi, grs. x. 

Iodi, grs. v. 

Glycerini, t ^i. 

Apply with brush in old cases with glandular enlargements. 

Tannic Acid, 3 ss. 

Glycerine, ,^i. 

Or, 

Alum, ^ss. 

Glycerine, ^i. 

Apply with a brush in acute aggravations with a tendency to 
ulceration. 



Or, 
Or, 



Fid. Ext. Hydrastis, 51. 

Glycerine, £i. 

PiniCanad., 31. 

Glycerini, gi. (Str.) 



The following is recommended as serviceable in 
offensive cases : 

Iodoform., grs. x. 

Acid. Tannici, gr. i. 

Sac. Lac, 5jss. 
This should be applied with a powder blower. (Str. ) 



OTITIS MEDIA. 389 

Injection of vapors or liquids into the tympanum 
through the eustachian tube, according to modern 
writers, has not been attended with satisfactory re- 
sults. Of the operative procedures excision of the 
drum head and the two larger ossicles appears to be 
the most satisfactory. (Bn.) 

ACUTE PURULENT OTITIS MEDIA : 

Severe cases should be confined to bed and the 
measures recommended for the acute catarrhal form, 
such as anodyne instillations, hot water douches, lo- 
cal depletion, and paracentesis are indicated. 

Heat: — Dry heat affords relief of pain, especially in 
the first stage. It may be applied in the form of hot 
bran, hot salt, or hot water bag. Moist heat may be 
conveniently employed by filling the upturned ear 
with water at a temperature of 105°, and applying 
immediately a hot flaxseed poultice, which in turn is 
covered with flannel. Douching the ear with hot 
water for ten minutes at a time is another method, 
but is not as convenient, and is no more effective than 
the above. (Bac.) 

Cold: — Leiter's coil constitutes the most effective 
mode of applying this agent, which is especially indi- 
cated when symptoms of mastoid inflammation are 
impending. (Dch.) 

Artificial Leech: — If the patient is seen in the early 
or hyperaemic stage, inflammation can frequently be 
arrested by the application of the artificial leech, 
either Burnett's, Heurtelope's, or Bacon's. These con- 
trivances are vastly superior to the ordinary leech. 
They should be applied in front, and below the 
tragus. (Bck.) 

The following anodynes will also be found useful 
for the relief of pain in the earlier stages: 



390 DIGEST OF EXTERNAL THERAPEUTICS. 

Atropiae Sulph., grs. ij. 

Acid. Borici, grs. x. 

Aq. Destill., |i. 

First warm and then drop into the meatus and insert a bit of 
cotton. 

Morphine, Atropine, and Cocaine, as mentioned in 
the acute catarrhal form, may be instilled for the re- 
lief of pain . 

Paracentesis: — The ear should be frequently exam- 
ined, and as soon as bulging of the ear drum is dis- 
covered, which usually occurs in the posterior half, 
the membrane should be relieved with a paracentesis 
needle. (Str.) 

After this it may be necessary to force out the se- 
cretion by the Politzer method. This should be done 
frequently during the course of the disease, very 
gently when there is pain and more forcibly as the 
acute symptoms subside. After paracentesis, the dis- 
charge should be promoted with the ear douche as in 
acute catarrhal otitis media. (Br.) 

Boric Acid: — A saturated solution warmed and 
dropped into the ear several times a day after 
thorough cleansing of the canal may be used with 
benefit after the acute symptoms have begun to 
abate. (Bn.) 

For antisepsis and cleanliness, solutions of Forma- 
lin, Bichloride of Mercury, Hydrogen Peroxide, 
Carbolic Acid, Creolin, etc., as mentioned under the 
chronic purulent form, will be called for. Boyle uses 
the f ollowing with good effect : 

Formalin, gtts. iii. 

Hydrogen Peroxide, 

Boric Acid, Saturated Solution, aa % ss. 

A few drops in the ear every two hours. 

Powders: — Remedies in this form are of service 
when the perforation is large and the inflammatory 
symptoms have not been severe. The same pow- 



OTITIS MEDIA. 391 

ders mentioned for use in the acute catarrhal form are 
also indicated in this variety. When the discharge is 
profuse and contains considerable mucus, remedies 
in this form should not be used. 

Astringent Injections: — Are indicated in place of 
powders when there is profuse mucous discharge, viz: 

Snlphate of Zinc, Acetate of Lead, Sulphate of 
Copper, all in the proportion of grs. ii— iv-^i. (Bn.) 

Injections of Warm Water: — Through the catheter 
into the middle ear are recommended in cases when 
pain continues uninterruptedly after perforation of 
membrana tympani in obstinate forms and in pain- 
ful inflammation of the mastoid process. (Fid.) 

Tr. Iron Chloride on a probe, Nitrate of Silver or 
fused Chromic Acid used with extreme care may be 
applied to the granulations which form on the edges 
of the perforation or in the middle ear. If chromic 
acid is used especial care must be taken to touch 
nothing but the granulation. (Bck.) 

The pharynx should receive treatment with sooth- 
ing sprays during the course of the disease. 

CHRONIC PURULENT OTITIS MEDIA (Otorrhoea) : 

Antisepsis and asepsis must be maintained. Some 
aurists prefer using a syringe as more effectual; 
others mop out the discharge with absorbent cotton 
on a cotton holder; then mop the whole external 
auditory canal and its fundus with cotton soaked in 
the antiseptic fluid, which is squeezed out into the 
parts. 

The following solutions are recommended for this 
purpose to be used warm : 

Formalin, 1-1000-2000. 

Carbolic Acid, 1-40. 

Mercuric Bichloride, 1-3000-4000. 



392 DIGEST OF EXTERNAL THERAPEUTICS. 

Salicylic Acid, grs. iii— gi. 

Creolin, 1-1000. 

Hydrogen Peroxide:— If the discharge is very thick 
a solution, 12 per cent., may be slowly instilled, ap- 
plying a few drops at a time until effervescence 
ceases. This remedy, of course, cannot be heated, 
and therefore must be used at the temperature of the 
atmosphere. (Str.) When the discharge is profuse, 
cleanse with the peroxide every two hours and dry 
thoroughly with absorbent cotton. (Bl.) 

After cleansing, the ear should be carefully exam- 
ined for granulations, polypi, denuded, carious, or 
necrotic spots in the bony parts, which if present 
should receive appropriate treatment. When asepsis 
has been established it should be maintained by appli- 
cations daily, or every other day, as the nature and 
quantity of the discharge indicates. For this pur- 
pose the antiseptic solutions mentioned may be 
employed with a mop or in the form of one of the 
following powders, the latter are generally regarded 
as superior, as the parts are thereby rendered 
aseptic more continuously. 

Boric Acid: — Pure, or Calendula mixed with Plan- 
tago. The latter is prepared thus : 1 part of sugar of 
milk is mixed with fluid extract of plant ago, as much 
being added as will thoroughly moisten the sugar. 
Triturate this in a mortar, add equal parts of boric 
acid; this, according to Houghton, gives better re- 
sults than the acid alone. 

An effective preparation is as follows : 

Iodoform, grs. ix. 

Tannic Acid, gr. i. 

Sugar of Milk, grs. xc. 
Triturate thoroughly. (Str. ) 

* Note. — Both Boric Acid and Iodoform have a tendency to 
cake in the ear, hence some caution is necessary in their use. 



OTITIS MEDIA. 393 

Resorcin, Aristol, Dermatol, pure, or mixed with 
Boric Acid and Hydrastinated Boric Acid, are 
recommended. 

Airol: — Has been used successfully. 

Oil of Eucalyptus:— 1 part, vaseline 8 parts, ap- 
plied on cotton, acts especially well in offensive cases. 
The patient may also use at night three or four 
drops applied on a piece of twisted cotton. (Str.) 

Various astringent solutions are also used, viz.: 

Zinc Sulph. grs. ii-^i. 

Zinc Sulpho-Carbolate, grs. v— ^i. 

Glycerite of Tannin, 

Nitrate of Silver, grs. i— x-^i. 

Acetate of Lead, grs. ii— ^i. 

Cadmium Sulphate, grs. ij— ^i. While more astrin- 
gent is at the same time more irritating than zinc. 

Treatment by antiseptic powders or instilla- 
tions should be applied daily for a few days ; then 
every other day, and at longer intervals as the dis- 
charge lessens. If, after a month or two, benefit is 
not observed, the mucous membrane of the drum 
cavity granulating or swollen, drainage defective, 
and the malleus or any part of the typanic walls, 
carious, the membranum tympani, the malleus and 
the incus should be removed by excision. (Burnett.) 

The granulations which may follow 7 chronic sup- 
puration of the middle ear usually disappear under 
treatment by antiseptic powders, but if such is not 
the case the following may be used: 

Alcohol instillations. 

Chromic Acid : — Dip a probe into deliquescent crys- 
tals and carefully apply, under powerful illumination. 
If done by an unskilled hand injury will be caused. 
Potass. Bichromate, saturated solution. Boric Acid, 



394 DIGEST OF EXTERNAL THERAPEUTICS. 

Alcohol, and Water, equal parts. The latter two 
are recommended by Sterling. 

PARALYSIS. 

Electricity: — Widely used in the various forms; in 
apoplectic paralysis it is often proposed, but the re- 
sults are not encouraging. In these conditions it 
should not be applied too soon after the seizure, and 
when applied to the head at least a month or so 
should have elapsed. (Gn.) Electrical treatment is 
much the same for all forms of cerebral paralysis va- 
rying only with the seat of lesion and the muscle s 
affected. (Rk.) Galvanism and faradism are both 
employed. De Watteville's method in hemiplegia is 
to apply a large electrode to the nape of the neck and 
the other, also large, on the diseased side so as to in- 
clude the seat of lesion between the two. In hemiple- 
gia the constant current may be applied to the brain 
to improve its nutrition and the faradic to the mus- 
cles to prevent atrophy and loss of function. (Bw.) 
If the muscles are weak and flabby much improve- 
ment will follow faradization. A current just strong 
enough to cause contraction should be used. The 
muscular contractions which ensue after a time, and 
which appear principally in the forearm and hands, 
may be treated by the continuous current to the 
flexors and an interrupted or faradic current to the 
extensors. (B.) 

In lead paralysis, if the muscles fail to respond to 
faradization and react -when stimulated by a slowly 
interrupted galvanic current, the interrupted gal- 
vanic current may be first employed followed by the 
faradic, when the muscles have so far improved as to 
respond to the latter. 



PARALYSIS. 395 

For facial paralysis the positive pole should be 
placed on the pes anserinus or on the mastoid process 
and the negative is passed over the peripheral expan- 
sion of the nerve, so that all the enervated muscles 
may be stimulated to contract. A current of suffi- 
cient strength to produce muscular contraction 
should be employed. 

In paralysis, of spinal origin, electricity will often 
give excellent results, but not, however, in all forms. 

In the infantile variety treatment should begin 
early, but after the inflammatory symptoms have 
disappeared good results are obtained by galvanism 
and faradism of the paralyzed muscles, as well as 
galvanization of the spinal nerves and plexus. (B.) 

*Chapman's System of Applying Heat and Cold to 
the Spine for paralysis and other diseases. A suc- 
cessful employment of Chapman's method demands 
a knowledge of the anatomy and physiology of the 
vaso-motor nervous system. 

To apply heat and cold, which are the essentials of 
the treatment, rubber bags are used. The apparatus 
for hot water consists of two narrow bags 8—10 
inches long kept parallel by cords or straps, the in- 
tention being to direct the heat upon the sides rather 
than the centre of the spine. For emergencies a yard 
of flannel 8-10 inches wide rolled from both ends 
nearly to the middle will answer. These parallel 
flannel rolls are to be dipped in hot water 115°— 120° 
F. and applied. Other excellent substitutes are Edi- 
son's electro-therm, the Japanese hand-warmer, hot 
salt or sand, or lime while slaking in flat metal 
boxes. 

* Condensed by Dr. Jas. Robie Wood, from his clinics at the 
Metropolitan Hospital, Blackwell's Island, New York, and espe- 
cially prepared by him for this work. 



396 DIGEST OF EXTERNAL THERAPEUTICS. 

Chapman's ice bag has no open space like the hot 
water bag, as it must cover the spine itself as well as 
its sides ; it is 10-18 inches long and about 4 inches 
wide, narrower for children and wider for very large 
persons. Usually there are 3 compartments, but they 
are not absolutely necessary. To prevent leakage 
the bag is securely tied or clamped at the top. When 
such a bag cannot be procured, an ox's gullet or a 
section of gut from any animal can be substituted. 
Chemical refrigerants may supply the place of ice. 

The ideas in the application of heat and cold to the 
spine are simply these : To contract arteries which 
are controlled from certain nerve centres heat 
should be placed close to those spinal centres ; this 
stimulates the vaso-constrictor nerve fibres and 
through them diminishes the calibre of arteries 
within their influence. 

Applied upon the same region the action of cold is 
directly opposite ; by reducing the circulation within 
and near the spinal column it partly paralyzes the 
vaso-constrictor filaments which supply the muscular 
walls of blood vessels, thereby permitting more or less 
dilatation of arteries under their control. 

To make use of this knowledge it must first be as- 
certained whether arterial narrowing or widening is 
demanded in any given disease ; in other words, con- 
ditions are the first consideration. For instance, in 
the same malady anaemia or hyperemia of che brain 
may occur. Now in cerebral anaemia, if an ice bag be 
applied over the lumbar and dorsal vertebras, that 
part of the spinal cord having no direct influence 
upon blood vessels within the cranium, the cold by 
causing dilatation of the small arteries of the abdo- 
men and legs would produce a rapid fall in blood 
pressure and syncope might result. 



PARALYSIS. 397 

On the contrary, heat upon the same locality, by 
inducing contraction of arteries in legs and abdomen, 
would increase the flow of blood to the brain. In 
cerebral hypersemia cold over the same vertebrae 
would relieve cerebral congestion, while heat would 
intensify that congestion. At the very onset of apo- 
plexy, in many cases, the dorso-lumbar application 
of an ice bag will control the cerebral circulation so 
as to prevent prolonged coma, and not infrequently 
consciousness will be restored within a few hours. 

In the cases of paralysis presented at this clinic to- 
day you have an opportunity of seeing the marked 
benefits of Chapman's system of treatment. None of 
these patients has had more than one hour's applica- 
tion of ice each day ; such chronic cases generally re- 
quire two or three hours' treatment daily. This old 
woman has had two attacks of apoplexy and has 
been paralyzed on one side for eight months. With- 
out assistance, other than a cane, she has walked 
down stairs to present herself at this clinic after four 
weeks' dorso-lumbar ice applications and an occa- 
sional laxative, which latter is very important dur- 
ing treatment at least once or twice a week. 

Here is a patient with both lower extremities par- 
alyzed and atrophied from spinal disease. Her most 
distressing symptom, constant involuntary discharge 
of urine and faeces, one week after the first dorso-lum- 
bar ice application, was under complete control. In 
other respects she has not as yet improved. 

Let me mention a few of the many maladies in 
which the Ice Bag applied upon the Dor so-Lumbar 
Region will be more or less palliative, if not always 
curative, when the proper conditions are present. 
They are acute and chronic cerebral and spinal con- 



398 DIGEST OF EXTERNAL THERAPEUTICS. 

gestions and inflammations, cerebral and spinal ap- 
oplexy, immediate or threatened sunstroke with cere- 
bral congestion ; paralysis from various causes, to 
supply nutrition when nerve degeneration is not too 
far advanced ; spasmodic diseases, such as epilepsy 
and some forms of general convulsions ; painful spas- 
modic affections dependent upon irritation of some 
portion of the spinal cord ; spasmodic contraction 
of muscles ; atrophied muscles and organs ; trismus 
and tetanus ; angina pectoris ; locomotor ataxia ; 
neuralgia ; neuritis and neurasthenia ; headaches, 
especially those from grief, mental and physical ex- 
haustion and alcoholism; many hysterical condi- 
tions; dysmenorrhcea particularly when complicated 
with headache ; amenorrhcea with or without mania- 
cal symptoms ; insomnia ; during chill of intermittent 
fever ; cold feet ; gastric disorders; constipation ; 
sporadic and Asiatic cholera ; chronic diarrhoea ; ob- 
stinate nausea and vomiting, especially seasickness ; 
eczema and some serious troubles of the eye. 

Heat may be applied in the Dorso-Lumbar Region 
in diseases attended with cerebral anaemia ; the hot 
stage of intermittent fevers; congestions and inflam- 
mations in various abdominal diseases, such as 
metritis, peritonitis, enteritis, nephritis and cystitis ; 
haemorrhages: uterine, intestinal, renal, cystic and 
gastric. 

Heat may be applied over the Middle and Upper 
Dorsal Vertebra? for pulmonary haemorrhages, con- 
gestions and inflammations, except when its action 
might impede the circulation of the heart and lungs by 
intensifying an already existing arterial constriction, 
a condition in which amyl nitrite, sodium nitrite or 
nitro-glycerine would be indicated. In such cases, 
heat between the shoulders would be harmful. 



PARALYSIS. • 399 

Heat may be applied to the Cervical Vertebra? in 
various congestions and inflammations of organs, 
glands and other tissues that are supplied by nerve 
filaments from the cervical sympathetic. Cold may 
be applied to the same region where anaemia or de- 
generation exists in those organs, glands and tissues. 

Where to place the Bags. The ice bag must not 
reach below the last lumbar vertebra, except in rare 
conditions to control the nervi-erigentes. A conve- 
nient rule is to place its lower end on a line with the 
crest of the ilia. Thence let it extend to the middle 
or upper dorsal vertebrae, according to the extent of 
the lesions. Cautions. The bag of ice must be pre- 
vented from slipping to the sides lest an annoying 
cold be developed. It is not well to apply ice imme- 
diately after a meal or while freely perspiring. The 
same care is not needed with the hot water bag, 
which may be placed at any indicated point along 
the spine. Don't persist in applying ice when it be- 
comes disagreeable and the patient feels chilled ; in 
such cases suspend the ice and administer laxatives, 
or apply heat on the same place. Where very rapid 
action is demanded to constrict blood vessels in the 
upper part of the body or head and dilate those of 
abdomen and legs at the same time, the hot water 
may be placed upon the upper dorsal and cervical 
vertebrae, while the ice bag is at the same time placed 
upon the lumbar and lower dorsal vertebrae. 

You .will be better guided by keeping in mind these 
statements of Chapman: 

1st. " By the Spinal application of Cold muscular 
tension is diminished; sensibility is lessened, secretion 
is lessened ; the peripheral circulation, and, conse- 
quently, bodily heat, are increased." 



400 DIGEST OF EXTERNAL THERAPEUTICS. 

2d. "By the Spinal application of Heat muscular 
tension is increased, sensibility is increased, secretion 
is increased ; the peripheral circulation, and, there- 
fore, animal heat, are lessened." 



PAROTIDITIS— MUMPS. 

Cotton Batting: — As a covering is all that is usually 
necessary in simple cases. There should be no coun- 
ter-irritation. (C.) 

Cold Cream or Vaseline:— Is often applied, and 
may possibly allay the sensation of tension. 

Belladonna or Phytolacca ointments: — May be em- 
ployed in conjunction with the same remedy inter- 
nally. (Ha.) 



PEDICULOSIS. 

PEDICULOSIS CAPITIS: 

The most expeditious measure is shaving the hair, 
and the application of some emollient for the eczema, 
which is usually present. This, however, is only ad- 
visable in the case of children and men in hospitals. 
But it is generally unnecessary, for the proper use of 
antiparasitics will accomplish the desired end. 
The following will prove satisfactory : 
Staphisagria: — Much used, and is generally effective. 
The decoction or tincture may be applied pure, or the 
fluid extract diluted with vinegar ; 1 drachm to the 
ounce of vinegar. (Al.) Another preparation is 
made by macerating 1 ounce of the seeds in a pint of 
vinegar. (F.) 



PEDICULOSIS. 401 

Kerosene Oil: — A remedy suitable for dispensary 
practice. Saturate the scalp and allow the oil to re- 
main on over night; do this for two days, then wash 
the head thoroughly with soap and water. It will 
kill the pediculi but not the nits. In applying the oil 
avoid letting it run down over the face and neck for 
fear of causing excoriation. 

Vinegar: — Will kill and loosen the nits and therefore 
should supplement the application of kerosene. (F.) 

Cocculus Indicus: — The tincture or decoction, is 
effective both for pediculi and nits. (F.) 

Startin recommended : 



Sod. Hyposulphit.. 


jfii. 


Acid Sulphurosi, Dil., 


£iv. 


Aquae, 


q. s. ad. ^xvi. 


Apply once daily. 





The following are useful : 

Hydrarg. Bichlorid., grs. iii-v— ^i. 

Carbolic Acid, grs. iii-iv, Alcohol, gi. 

/3-Naphthol, 5 per cent, in oil. 

When the hair is short, ointments may be employed 
advantageously, viz: 

Hydrarg. Ammon., grs. xx-3i-|i. 

Staphisagria seeds, in powder, gi, Lard, gi. 

Carbolic Acid, grs. xv-xxv, Ung. Petrolei, gi ; the 
last is said to be the most effective. 

PEDICULOSIS CORPORIS: 

Administer a Hot Bath with plenty of soap and boil 
or bake the clothing. When this is not practicable, 
iron the seams to destroy parasites and ova. After 
the bath use inunctions, viz : 

Staphisagria: — The powdered seed, 3H, lard, ^i 
(Vn.), or the oil, si, with ammoniated mercury, ^iii, 

lard to §i. (T. 96.) 

27 



402 DIGEST OF EXTERNAL THERAPEUTICS. 

Carbolic Acid: — 3m, glycerine, 31, water, Oj. 

Paraffine Oil: — Said to be the most certain and 
speedy remedy. 

Sulphur: — A small piece about the size of a pigeon's 
egg may be worn next to the skin night and day. 
The remedies for pediculosis capitis are also of use 
in this condition. 

PEDICULOSIS PUBIS: 

The parts should be washed with soap and water 
dairy and the remedy applied for some days to in- 
sure the destruction of the ova. Effective applica- 
tions are as follows : 

Hydrarg. Bichlorid., grs. ii-iv, alcohol or water, gi. 

Ung. Hydrarg. Oleat., 10-20 percent. 

Ung. Hydrarg. Ammoniat. 

Naphthol, 5—10 per cent, solutions. (F.) 

The following other agents are also useful (Sm.): 
Ointments of Veratrine, Sabadilla Seeds, ,2-Naph- 
thol, 10 per cent., Losophen, 10-20 per cent., Oil of 
Rosemary, Solution of Creoline, about 2 per cent. 



PELVIC INFLAMMATION. 

ACUTE: 

In view of the intimate anatomical, pathological, 
and clinical association of the uterine appendages, 
and of the similarity of the external remedial meas- 
ures which are employed for the relief of morbid con- 
ditions in these parts, salpingitis, oophoritis, pelvic 
cellulitis, and pelvic peritonitis will be considered col- 
lectively. 



PEMPHIGUS. 403 

Rest in bed ; Hot Fomentations over the hypogas- 
trium (K. C), careful antisepsis of vagina, and pro- 
longed vaginal Douches of hot water as in acute me- 
tritis. (Pz.) 

Cold: — In the form of the ice bag, will be found ser- 
viceable in some cases. (Dud.) 

For the relief of pain small Blisters over iliac re- 
gion, followed by the application of Morphine and 
painting with Iodine. The administration of ano- 
dyne injections is useful for oophorosalpingitis. 
If an external wound is the source of infection, it 
should be cauterized. (Dud.) 

Operation is advised at the moment sepsis ap- 
pears, viz: The Free Opening into the depth of the 
inflamed mass, and drainage. (K. C.) 

After the acute symptoms have subsided vaginal 
tamponade should be employed, as in chronic endo- 
metritis. 

CHRONIC: 

Treatment is generally on the same lines as in 
chronic endometritis and metritis. 

Laparotomy: — Pozzi says: " That whatever may 
be said to the contrary, a laparotomy, or even an ex- 
ploratory incision, is not justifiable for the mere re- 
lief of persistent pain in the vicinity of the append- 
ages." Purulent forms demand surgical interference. 



PEMPHIGUS. 

The blebs are to be punctured and evacuated as 
soon as formed and the parts anointed with Zinc 
Oxide Ointments. 



404 DIGEST OF EXTERNAL THERAPEUTICS. 

Soothing and astringent lotions and dusting pow- 
ders are indicated, especially the latter. Of the lo- 
tions, Lime Water, Thymol, 1-1000, solutions of 
Borax, Lotio Nigra and Liq. Plumbi Subacetatis 
may be used as in acute eczema, and of the powders, 
Zinc Oxide and Starch, equal parts, Bismuth, Lyco- 
podium and Dermatol ha^ve proved of benefit. 

Tumenol: — 2-5 per cent, solution applied with 
compresses has been found valuable, so has an 
ointment of tumenol oil containing from 5-10 per 
cent, of the oil, mingled with 5 per cent, oxide of bis- 
muth and oxide of lead, with lard as a base. (F.) 

Baths containing Bran, Starch, or Gelatine, and in 
some cases, the Continuous Warm bath as recom- 
mended by Hebra. Corrosive Sublimate and Alka- 
line baths will also sometimes prove of service. (Pp.) 
After the baths, dusting powder or ointments may 
be applied. 

Hardaway recommends Lin. Calcis, 1 ounce, with 
Creosote, 1 minim. 

Unna recommends equal parts of Linseed Oil, Lime 
Water, Zinc Oxide and Chalk, both for drying up 
and for preventing the formation of bullae. 

Ointments: — Are sometimes useful, as water does 
not always agree. The following may be used : 
Vaseline, Rose Water Ointment, Lanolin, with or 
without 5—10 per cent, of Zinc Oxide, or Bismuth 
Subnitrate, or with 3-5 per cent, of Ichthyol or Sul- 
phur. (Mor.) Lassar's paste, Zinc Oxide or Diachy- 
lon ointment. (Ck.) 

/?-Naphthol: — A 10 per cent, ointment, is useful for 
the itching. 

Europhen: — Used in the strength of 10 per cent., is 
also effective. (T. 98.) 



PERICARDITIS. 405 

Ointments should be spread on cloths and bound 
down with bandages. 

Nitrate of Silver:— Grs. ii-^i, was employed by 
Erasmus Wilson after the bullae had ruptured. 



PERICARDITIS. 

Prompt treatment is of the greatest importance. 

Rest in bed is absolutely essential; under Ho cir- 
cumstances should the patient be permitted to leave 
it. (Gn.) 

Hot Applications:— Generally grateful. Poultices 
tend to relieve pain, and by dilating the superficial 
vessels drain the deeper. If applied in the usual 
way they will be too hot, and if of the proper tem- 
perature at the time of application they will soon 
cool, therefore, apply first over the heart a thick flan- 
nel and over this the poultice. The heat, which now 
will not burn, may be maintained for a much longer 
period. (Gn.) 

Morphia and Atropia: — Moderate doses of these 
remedies associated, administered hypodermically, 
are very satisfactory for the relief of pain. Morphia, 
i/4 gr.; atropia, T ^ gr. (Ty.) 

Blisters: — Strongly advocated s by some of the most 
modern authorities, to be applied as soon as diagno- 
sis is made. A blister at least three inches square is 
to be applied over the precordial sac. There is no 
other disease, says Tyson, in which this agent gives 
more satisfaction. 

Cold Applications: — While heat is generally more 
grateful the ice bag, or Leiter's coil, are effective in 
some cases, affording great relief and apparently 



406 DIGEST OF EXTERNAL THERAPEUTICS. 

controlling inflammation. (Gn.) Cold sponging or 
even the cold pack may be used in cases attended 
with intense hyperpyrexia. (L. T.) 

Paracentesis: — If effusion is considerable, immedi- 
ate puncture of the pericardial sac must be consid- 
ered. The puncture should be made in the fourth 
interspace one inch to the left of the sternum, first 
carefully dividing with the scalpel the skin and under- 
lying tissues, until the pericardium is reached, then 
puncture with trocar. When the effusion is purulent 
free incision may be made, and drainage established, 
with proper antiseptic precautions. (Gn.) 



PERIOSTITIS AND OSTITIS. 

(Compare Nodes.) 

In the acute forms, Rest in bed and elevation of 
the parts ; a few Leeches over the inflamed point 
will do much to relieve pain. This may be followed 
by Hot Fomentations or Goulard's Solution with 
Opium. (HI.) 

Compound Mercurial Ointment: — Applied as fol- 
lows, frequently has a beneficial effect: Spread the 
ointment on lint and apply it all around the limb. 
Then straps are firmly and evenly applied from some 
distance above to some distance below the seat of 
inflammation ; over the whole a starch or gum band- 
age is placed. Thus pressure as well as the action of 
the mercury are obtained. (HI.) 



PERITONITIS. 407 



PERITONITIS. 

Local measures for the reduction of inflammation 
do not play a very important role. 

Heat: — Most useful in allaying pain and may be 
applied in the form of hot water bag, flannel wrung 
out in hot water and covered with oiled silk, or light 
flaxseed poultices, frequently applied, and covered 
with cotton and soiled silk. As the hot water bags 
are generally too heavy to be placed over the sensitive 
abdomen they can' be placed at the sides and assist 
in keeping the light poultices warm. (Ty.) 

Cold: — In the form of compress is preferred by some 
writers, who claim they do more good than hot ap- 
plications; they are certainly preferable in some cases. 
(Rd.) Ice Bags may also be used for the relief of 
pain. 

Turpentine: — Stupes are employed for the relief of 
tympanitis ; flannels are wrung out in hot water and 
sprinkled with turpentine, or equal parts with sweet 
oil, using about 2 drachms of the mixture, which 
may be spread on poultices. (L. T.) 

Counter- Irritation:— Such as blisters, may be of ser- 
vice in some cases, but only when disease is local and 
not when the inflammation is general. 

Leeches: — Are generally condemned (L. T.), but in 
sthenic types, in plethoric persons, when the inflam- 
mation is localized, they are advocated by some 
authorities. (Ty.) 

Intravenous Saline Injection: — This method has 
been employed in three cases of septic peritonitis, 
when death seemed inevitable, with two recoveries. 
The first case was ruptured intestines from the kick 



408 DIGEST OF EXTERNAL THERAPEUTICS. 

of a horse; there were well marked symptoms of 
acute peritonitis, the abdomen was opened and in- 
testines sutured. Three subcutaneous injections (16 
oz. each) of artificial serum were made on the next 
two days, but condition appeared hopeless on third 
day when two pints of artificial serum were injected 
intravenously ; there was immediate improvement 
for several days. Three injections of three pints 
were administered, which caused profuse diuresis and 
diarrhoea. During one week after the operation 
nearly 40 pints of artificial serum were given. On 
the ninth day injections were discontinued and con- 
valescence was well established! The other cases 
were as follows : Peritonitis following operation for 
tubal pregnancy, and peritonitis as a sequel of rup- 
tured typhoid ulcer. The former case recovered ; the 
latter died. The injections did not cause either albu- 
minuria or hematuria. Occasionally a little pain 
and dyspnoea occurred, but not of long duration. 
The serum used was the following: 

Chloride of Sodium, 75 grains. 

Sulphate of Sodium, 150 grains. 

Distilled Water, i# pints. (T.97.) 

TUBERCULAR PERITONITIS: 

Simple Incision with Free Evacuation: — Most suc- 
cessful of any of the measures employed ; the best re- 
sults were obtained when the abdomen was neither 
flushed out nor drained, but when the effusion had 
been simply evacuated and the wound closed. (T. 97.) 

Collodion: — Several cases have been reported by 
French physicians in which repeated applications to 
the abdomen over its entire surface have been fol- 
lowed by recovery. (Sm.) 



PERNICIOUS MALARIAL FEVER. 409 



. PERNICIOUS MALARIAL FEVER. 

A reaction should be brought about at once. If in 
the cold stage, apply Heat to the surface. When 
there is cerebral congestion Cold to the head. Cold 
is contra-indicated if the face is pale. Remissions are 
greatly promoted by the free and frequent use of 
Hot Mustard Foot Baths. (Rd.) (Ga.) 

Quinine: — Hypodermicalry, is advised in all va- 
rieties of pernicious intermittents ; the patient should 
be cinch onized and kept so for several days. (An.) 

The soluble salts should be used, such as the tan- 
nate, hydrobromate and hj^drochlorate, in doses of 
15 grains in distilled water, with 1 grain of sodium 
chloride. The bisulphate in doses of 30 grains, with 
5 grains of tartaric acid, may also be given. The 
muriate of quinine and urea, in doses of from 10—20 
grains, may also be administered. These doses may 
be much increased if necessary. The liability to the 
formation of abscesses after the hypodermic adminis- 
tration of quinine must be taken into consideration. 
(Ty.) 

Amyl Nitrite: — Inhalation may modify the cold 
stage, but has no influence on the hot. 



PERTUSSIS. 

Of the numerous agents used specially for their 
germicidal and antispasmodic effects, the following 
may be commended : 

Carbolic Acid:— A solution of 5-1000, as a spray, 
seems to be valuable, and is much used. (Ty.) 



410 DIGEST OF EXTERNAL THERAPEUTICS. 

- A form of the crude acid is sold tinder the name of 
Cresolene, the vapor of which is allowed to impreg- 
nate the apartment. The remedy is prepared for 
vaporization by heating, and it is thought to modify 
the disease. 

Resorcin: — One per cent, solution, applied to 
larynx, is very effective. (T. 98.) 

Hydrogen Peroxide:— Is the best and least irritat- 
ing antiseptic applicaiton for this disease. It should 
be sprayed directly into larynx two or three times a 
day, in the strength of 30 volume peroxide (hydro- 
zone), 1 part ; distilled water, 10 parts; glycerine, IY2 
parts. Hydrogen peroxide is also used diluted with 
2 parts Dobell's solution. It is discountenanced by 
Goodno. 

Menthol: — 20 grs. in liquid vaseline in an ordinary 
nasal spray, as soon as paroxysm begins, or seems 
impending. Diffuse a fine cloud of spray in front of 
the face, the spray being held about two feet away. 
The effect is beneficial, the paroxysm soon over, and 
mucus rapidly expectorated. 

Boric Acid: — Insufflation of 3 grains into nose 
every three hours. (Sn.) 

Nitrate of Silver: — Used as a spray in 1—2 per cent, 
solution (Jac). It stains clothing, however, and is 
not applicable to young children. 

Chloroform or Ether Inhalations: — Preferably the 
former, are very beneficial when convulsions have oc- 
curred, or are feared; also the following combination: 

Chloroform, 3;j. 

Ether, Sulphuric, ^ij. 

Ess. Terebinth, Rect., .^iiss. 

Pour a teaspoonful upon handkerchief, and hold to child's nose 
during paroxysm. (Sn.) 

Hydrarg. Bichlorid.:— Sprays of 1-4000 solution 



PERTUSSIS. 411 

(Ty.). Caution evidently necessary, as to frequency 
of application and quantity applied. Rabinschek's 
method (B. M. P., 8, 13, 96); consisting of the intro- 
duction into the back of the mouth of a small tam- 
pon saturated with a solution of 1—1000, which is 
pressed against the base of the tongue, so as to ena- 
ble the solution to bathe the epiglottis and neigh- 
boring parts, is said to be efficacious ; but, inasmuch 
as in a small number of cases temporary disturb- 
ances have been observed, such as haemorrhages of 
the conjunctiva and the ear, buccal ulceration, and 
slight fever (which were described by the author as 
not at all serious), this method of treatment would 
scarcely seem to be advisable. 

Thymol: — Inhalations are sometimes serviceable. 
A good formula is as follows : 

Menthol, 
Thymol, 

Carbolic Acid, aa grs. v. 

Oil of Eucalyptus, ^ii. 

Oil of Pinus Sylvestris, ^ iii. 

A teaspoonful to about a pint of boiling water or a few drops 
on cotton, inhaled. (F. ) 

Sodium Sozoiodate: — The powder blown into the 
nose in doses of 3 grs. dailv is said to be effective. 
(F.) 

Ozone: — The sick room may be charged with the 
gas in moderate quantities with benefit, improving 
the condition of the patient, and minimizing conta- 
gion. (F.) 

Poultices: — Large enough to cover posterior sur- 
face of lungs ; on this the child is made to lie for one 
hour. Relief is almost immediate. After removal, 
rub in skin previously covered by poultice sweet oil 
and camphor then apply cotton jacket. (Sj.) 



412 DIGEST OF EXTERNAL THERAPEUTICS. 

Asparol: — 1 per cent, aqueous solution applied on 
gauze over periglotteal region. (Sj.) 

Carbonic Acid Gas:— Inflation of rectum with this 
gas has been attended with success. (F.) 

Formaldehyde: — Is used successfully as a spray 
three times daily for fifteen minutes at a time. (F.) 
Inhalations are also recommended, the patient is 
propped up, and the spray is applied within this 
wrapping for two or three minutes. The paroxysms 
are diminished, both in frequency and intensity. (Sj.) 

Cocaine Hydrochlorate:— A 5 percent, solution to 
the pharynx. (Jac.) 

Amber Oil: — Useful as an embrocation, enters into 
the combination of a well known English nostrum 
called " Roche's Embrocation," which is composed of 
olive oil mixed with half its weight of oil of cloves 
and oil of amber. (Cool.) 

Sulphur Fumigations: — Of sleeping apartments 
have given good results. Remove the child from the 
room in the morning, wash and dress in clean, fumi- 
gated clothing ; then close room to be fumigated for 
four or six hours, allowing sulphur to be freely 
burned in it. (Gn.) 

Eucalyptol: — The fumes as an inhalation, or a 
spray as follows : 2 drachms of the oil w T ith 2 of tere- 
bene, and alcohol IV2 oz.; apply half an hour before 
each meal, and at bed time. (F.) 

Quinine: — Insufflations have been employed, and 
considerable doses have been given to be slowly 
swallowed for their topical effect. Sprays were 
formerly much employed. 



PHAGEDENA. 413 

PHAGEDENA. 

(See also Gangrene.) 

Nitric Acid: — The foremost topical remedy steeps 
the effected part with the fuming acid ; if ulceration 
is extensive, chloroform may be administered. 

Bromine: — In using this agent it should be remem- 
bered that it is one of the most powerful escharotics, 
its action being not altogether controllable. It 
causes widespread destruction of the tissues which 
areslow to heal. Its use in the pure state is mostly 
confined to hospital gangrene. An aqueous, T \ per 
cent, solution, is employed for washing phagedenic 
wounds. All disorganized tissues should be first re- 
moved by hydrogen peroxide irrigations, the scissors 
and forceps. Then irrigate with the bromine solu- 
tion. If gangrene is extensive, pure bromine may be 
used, the patient being under an anasthesia. Com- 
presses wet with the bromine solution are placed 
over the wound, covered w4th oiled silk, and a band- 
age. Dressing should be changed every twelve to 
twenty-four hours for the first two to four days, 
when the granulating surface should be clean. Then 
change to simple sterilized water dressings, or one 
containing 1 per cent, of sodium chloride, [or 5 per 
cent, of boric acid. (F.) 

Carbolic Acid: — The undiluted acid is superficial in 
its effects, but will be found very useful in mild cases. 
(N.) 

Potass. Chlorate: — The powder thickly sprinkled 
over sore, proves a manageable and effective remedy. 
(B.) 



414 DIGEST OF EXTERNAL THERAPEUTICS. 

Hydrated Silica:— This substance is a jelly-like 
mass and is prepared by Dr. H. G. Piffard according 
to a process devised by Dr. C. Rice. It is said to be 
most effective in controlling profuse suppuration. 

The silica is packed closely in the part, and the 
dusting renewed once or twice a day. If applied too 
long it will devitalize the tissues and cause extensive 
sloughing. (F.) 

Pyrogallic Acid: — A powder made of one part of 
the acid with four of starch has been found effective. 
(F.) 

Mercuric Nitrate:— A useful caustic; its especial 
value is its speedy destruction of rapidly advancing 
ulceration. (F.) 

Zinc Chloride: — This powerful caustic may be 
dusted, in the form of a powder, over the ulcerating 
surface. A superficial slough forms, which may be 
removed by poultices. (B.) 

Salicylic Acid, Boric Acid, Europhen, Iodoform, 
and Xeroform, applied to the sloughing surfaces and 
adjacent healthy tissues, are all effective when dust- 
ing powders are indicated. 

Immersion in Hot 'Water: — As recommended by 
Mr. Hutchinson. The past is placed in a bath at a 
temperature 95°-98° and allowed to remain for eight 
hours at a time. After two or three baths a healthy 
appearance may be looked for. This method is said 
to have been very successful in the treatment of phag- 
edoena of venereal sores. 

Cauterization: — By the galvano-cautery or Paque- 
lin, preferably the former, will sometimes arrest the 
morbid process when other measures have failed. 

For cleansing and deodorizing, solutions of Hy- 
drarg. Bichlorid., 1-2000; Hydrogen Peroxide, pure 



PHARYNX, ADENOID GROWTHS. 415 

or diluted ; Carbolic Acid, in various strengths ; Po- 
tass. Permang., about 5— 10 grains to the ounce, and 
Labarraque's solution. 



PHARYNX, ADENOID GROWTHS. 

(Hypertrophy of the Pharyngeal Tonsil.) 

Mild treatment should be tried first. The follow- 
ing are of service : Sod. Benzoat, grs. x-^i; Potass. 
Chlorat., grs. xx-^i; Dobell's Solution, or either of 
the following formulae : 

Fid. Ext. Hamamelidis, Destill., 

Aq. Rosae, aa. ^ii. 

Or, 

Ivisterine, 3 iv. 

Sod. Bicarb., 

Sod. Biborat., aa grs. viij. 

Aq. Rosae, q. s. ad. ^iv. (Bn.) 

Tannin: — One of the best applications, a solution 
of 40 grs. to the ounce of glycerine, painted on with 
a suitably curved post-nasal applicator, after the 
use of sprays (B.); or the following combination: 



Acid. Tarmici, 


grs. xl. 


Acid. Carbolici, 


•gr- j- 


Sodii Biboratis, 


grs. xx. 


Glycerini, 


^ss. 


Aquas, 


ad. ifiv. 


This may be applied twice daily. 


(Bos. ) 



Resorcin: — 100 per cent, solution has been used 
successfully, one observer declaring that it obviates 
the need of surgical measures. The time required for 
treatment, however, was from two to four months. 
(T. 98.) 



416 DIGEST OF EXTERNAL THERAPEUTICS. 

When milder measures fail, chromic acid, the gal- 
vano-cautery, the curette, or forceps should be em- 
ployed for the removal of the growths. (Iv.) 

Chromic Acid: — May be applied on a probe in the 
form of the fused crystals or in a saturated solution, 
preferably the former. Applications should be 
guarded, and the rhinoscopic mirror used. Three or 
four applications may be made at weekly sittings, 
the saturated solution on cotton being used. Care 
must be exercised lest the acid flow down the throat 
and cause severe inflammation and spasms. (Iv.) 

Galvano-Cautery : — Among the most efficient 
methods of treatment, a good practice is to burn 
away two or three prominent nodules at each sit- 
ting, repeating the operation in a week or two if nec- 
essary. This method, however, is not adapted to 
children. (Bh.) 

Curettage: — For this purpose employ Meyer's 
method, an L shaped curette, finger curette, or the 
finger nail; general anaesthesia and antisepsis also 
are necessary. Some writers regard this measure as 
peculiarly dangerous, and only to be performed by 
an expert. It is not adapted for use with children. 

Curved cutting and crushing Forceps are used to 
tear away the growths. The haemorrhage is quite 
profuse for a time, but soon subsides. 

Supra- Renal Extract: — The recent introduction of 
this agent for operations on the nose and throat is 
apparently only second in importance to that of co- 
caine. It is a powerful vaso-constrictor and con- 
tractor of erectile tissues. By its use it is said that 
nose and throat operations can be greatly facilitated 
and rendered almost bloodless. 

Its blanching properties are very powerful ; a drop 



PHARYNGITIS. 417 

of a 1 per cent, solution instilled into the eye will 
produce, it is claimed, an ivory whiteness of lid and 
conjunctiva in less than one minute. It is painless 
and non-reactionary. A tolerance is not established 
by its use and there does not appear to be any danger 
to the tissues or the individual. Such at least are 
the claims. The remedy also has been used mixed 
with cocaine. 



PHARYNGITIS. 

ACUTB CATARRHAL PHARYNGITIS: 

Many simple cases disappear without treatment. 
Twenty -four hours in bed is about the best medicine. 
Local applications, when required for the comfort of 
the patient should be astringent and soothing. They 
maybe administered in the form of sprays, gargles or 
inhalations. Gargles are of utility if used according 
to the method of Hagen, otherwise the fluid rarely 
passes beyond the pillars of the fauces. Hagen ad- 
vised that the mouth be a little more than half filled 
with the gargles, the head bent back, the mouth open 
and a complete act of deglutition performed with the 
mouth still open ; the air is now allowed to gargle 
through the solution as long as possible, and then it 
is expelled. (Iv.) 

The following are for use as gargles or sprays in 
solution with 1 ounce of water : 

Potassium Chlorate, grs. x— v. 

Sodium Biborate, grs. x. 

Sodium Bicarbonate, grs. viii. 

Alumin, grs. v. 

Tannic Acid, grs. v. 
28 



418 DIGEST OF EXTERNAL THERAPEUTICS: 

Rhus Glabra: — Said to be one of the best remedies 
as a gargle; use 2 drachms of the fid. extract to 4 
ounces of water, to which 2 scruples of Chlorate of 
Potash have been added. (Al.) 

Fluid Petroleum Preparations:— Such as benzoinal, 
albolene, etc., are often very soothing when applied 
in the form of sprays. 

Tannic Acid: — 15 grains to 1 ounce of water, 
is of service when there is oedema. (Iv.) 

Menthol: — An agreeable application, has positive 
value in controlling inflammation. Sprays of from 
2-5 per cent, are agreeable and effective palliatives. 

Lozenges: — Are often of service in allaying the irri- 
tation of the throat ; the following are recommended, 
the latter being indicated when there is considerable 
secretion which is not easily expectorated (Bos.): 



Ext. Eucalypti., 






3ss. 


Sod. Biborat., 






grs. x. 


Pulv. Piment., 






grs. vii 


Ext. Glycyrrbyz., 






^iiss. 


Ft. Mass. in trochisca, No. 


XXX 


div. 




Ammon. Muriat., 






3ss. 


Pulv. Ipecac, 






grs. ij. 


Pulv. Capsici, 






gr. ss. 


Ext. Glycyrrhyz., 






3 iiss. 


Ft. Massa in trochiscas No. 


XXX 


. 





The following in solution with 1 ounce of water : 

Acetanilid, grs. iv. 

Tr. Capsici, gtts. iii— iv. 

Tannate of Glycerine, gi. 

Gallic Acid, mixed with Tannic in proportion of 
1-3, said to modify irritating effects of the latter; 
about 5 grains of the mixture to 1 ounce of water. 

Hamamelis, Aqueous Ext., about ^iiss. (Sn.) 

Thymol:— Solution of 1-1000-2000, is especially 



PHARYNGITIS. 419 

valuable in exanthematous variety. (Al.) (See Scar- 
let Fever.) 

Inhalants: — Are sometimes effective in soothing the 
irritation ; the following are suggested : 

Benzoic Acid, 3 grains with 12 grains of Kaolin ; 
rub well together and add Tr. Tolu, 18 drops, and 
water, 1 ounce. Add one teaspoonful to a pint of hot 
water and inhale vapors. (Lefferts.) 

Thuja, a few drops of the essential oil in a pint 
of water, temperature 140°. (Al.) 

Chamomile, infusion is useful for children. (Al.) 

Cold: — Ice water compresses to the throat or small 
ice bags with dry towels covering; also sucking 
small pieces of ice. 

Counter- Irritation: — Mustard leaves sometimes 
better than cold, as all throats do not bear cold 
equally well. (Ty.) 

Scarification of Uvula: — When the uvula is very 
cedematous and elongated, it is the source of con- 
stant irritation, and discomfort, in which condition 
scarification or puncture will afford prompt relief. 

(Pp.) 

CHRONIC CATARRHAL PHARYNGITIS: 

This condition is usually secondary to some other 
affection, such as naso-pharyngeal catarrh, obstruct- 
ive lesions of the nose, excessive use of tobacco, or 
chronic gastric catarrh. Treatment, therefore, should 
be directed toward eliminating these causes ; at the 
same time, local application should be made to the 
pharynx every two or three days. 

The throat should first be cleansed with some anti- 
septic or alkaline spray, such as Dobell's or Seiler's 
Solution. This constitutes a very important meas- 



420 DIGEST OF EXTERNAL THERAPEUTICS. 

ure. After cleansing, the selected remedy may be ap- 
plied; the following solutions will be found of service: 

Potass. Bichromate, 1 percent.; Potass. Permang., 
1 per cent.; Sodium Bicarbonate, 5 per cent.; Euca- 
lyptus, 10 per cent. 

When the above have failed, one of the following, 
combined with 1 ounce of Glycerine is used, Tan- 
nic Acid, grains 10; Zinc Chloride, grains 5; Iodine, 
grains 10. (Iv.) 

The following are also recommended : Argent. Nit., 
grains 10-20 to the ounce; Zinc Sulphate, grs. 10- 
20 to the ounce; Liq. Ferri. Persulph., M. x to the 
ounce. 

Pyoktanin Blue: — 7Mj grs. with 2 drachms of wa- 
ter ; 10 minims of this solution with 1 ounce of gly- 
cerine; apply with brush, especially when hypersecre- 
tion is a prominent symptom. (Iv.) 

Glycerine: — Painting the throat is of value, as this 
agent depletes the mucous membrane. (Gn.) 

Cold Salt Water: — As a preventive ; bathe neck and 
upper part of chest with cold salt water, and after- 
ward rub with rough towel; avoid muffling neck. 

CHRONIC FOLLICULAR PHARYNGITIS: 

Galvano- Cautery: — While there is some divergence 
of opinion in regard to the expediency of destroy- 
ing the enlarged follicles by cauterization before em- 
ploying milder measures, it seems to be the gener- 
ally approved method for the cure of this affection. 
The best agent to employ is the electro-cautery. 
Each follicle is touched with the needle once, and, in 
the case of very large follicles, several times. The 
needle should be fine and brought to a red heat. It is 



PHARYNGITIS. 421 

advisable to go over the pharynx at intervals of a 
week until inspection shows all enlarged glands to 
have been eradicated. 

While many writers consider the above the only 
satisfactory treatment, other and milder measures 
are recommended and approved. Some of these are 
as follows : 

Nitrate of Silver: — Solutions of 40—60 grains to the 
ounce, have been employed after the removal of the 
mucus. The hypertrophied tissues are to be touched 
individually. Another method of application con- 
sists in splitting the follicle with a knife, and crowd- 
ing in the silver. (Ing.) The knife and caustic may 
be advantageously employed when the cautery is not 
available. (L. B.) 

Curettage: — Recommended bj- Lennox Browne in 
obstinate cases. 

Hydrastine: — By insufflation, is indicated in cases 
where the follicles are of a deep red color, where the 
surrounding mucous membrane is moist and the secre- 
tion, except in the naso-pharynx, is not excessive; use 
hydrast. muriat., grs. xxv ; acacias, q. s. ad grs. c. 
At first use small quantities only in order to ascer- 
tain susceptibility of patient, as remedies applied in 
this way sometimes cause pain. (Ing.) 

Astringent sprays of Cup. Sulph., Zinc Chloride, 
Zinc Sulphate, 10-20 grs. of either to water 1 
ounce, will occasionally prove useful. (Ing.) 

Pyoktanin Blue: — Saturated solutions applied to 
each follicle are recommended. (Gn.) 

Iodine: — A solution in glycerine. (Gn.) 

Mineral Cauterants: — The following may be em- 
ployed when follicles are much enlarged : Nitric Acid, 
Chromic Acid, and London Paste applied carefully to 



422 DIGEST OF EXTERNAL THERAPEUTICS. 

each follicle individually. These caustic applications 
may be repeated in four or five days. (Ing.) Zinc 
Chloride, 20-40 grs. to the ounce, is also applied to 
the indurated tissues. These measures, for the most 
part, are now obsolete. 

Krameria: — Will form a mild troche; useful as a 
palliative astringent, about 3 grains to a troche, 
or the following in each : 

Ext. Krameria, gr. i. 

Pulv. Cubebs, gr. \. 

Potass. Chlor., grs. ii. (Ing(. 



PHLEBITIS. 

Rest in bed constitutes the first essential of treat- 
ment. The affected part should be elevated if possi- 
ble and enveloped in cotton. 

Ice applications should be applied to the parts 
when the temperature is high. (Gn.) 

Hamamelis: — Applied on compresses acts well. 
(Rd.) 

The following anodyne preparations are recom- 
mended : 

Ext. Belladonnse, 

Ext. Hyoscyami, aa grs. xxx. 

Adipis Benzoat. , Ji. 

Or, 

Chloroformi, 

Lin. Camphor., a a £ii. 

Glycerini, 3 iv. 

Or, 

Ichthyoli, grs. xv. 

Iyanolini, 3j. 

(T. G., 9, 15, 96.) 



PITYRIASIS CAPITIS. 423 

Goulard's lotion with Opium: — A useful anodyne 
lotion. (HI.) 

Free Incision: — Is indicated, if suppuration ensues ; 
the incisions are made parallel to the veins, and free 
drainage established. A wet dressing should be ap- 
plied, and the wounds freely irrigated with sublimate 
solution 1-1000. (W.) 



PHLEGMASIA ALBA DOLENS. 

(See Phlebitis.) 

PITYRIASIS CAPITIS. 

Treatment of this affection is chiefly local. Before 
the application of any remedy first clean the scalp 
with soap and water, or if the crusts are very thick 
soften them with olive oil and then shampoo the 
head with Spts. Sapo. Kal. According to Hebra,this 
remedy is made by dissolving 2 drachms of the green 
soap in 1 ounce of alcohol ; perfume if desired with oil 
of lavender, or bergamot. Apply the soap with 
water, a teaspoonful with a tablespoonful of water, 
well worked up into a lather, and quickly clean the 
scalp. Afterwards cleanse with cold water and ap- 
ply the selected remedy. In ordinary cases where 
the scales are loose and dry, remedies may at once 
be applied, such as the preparations of resorcin, sul- 
phur, and salicylic acid. 

Lotions are generally best when the hair is thick ; 
ointments are useful when it is thin. The following 
are well attested formulae : 



424 DIGEST OF EXTERNAL THERAPEUTICS. 

Resorcin: — Gives excellent results, useful in obsti- 
nate cases, and in those in which there is considerable 
effluvium capillorum, viz: 

Resorcin., 9iv— ^ii. 

Ol. Ricini pur., ^iv. 

Alcohol fort., ^v. 

Balsam Peru, gtts. xii. 
Rub in scalp once or twice daily. 

Or, 

Resorcin., grs. x-xx. 

Sulphur. Prsecipit., £i. 

Ung. Aquae Rosas vel. Ung. Simp., ^ij. 
Rub in scalp once or twice daily. 

If resorcin is used alone it should be dissolved in a 
bland oil. (B. H.) 

Salicylic Acid: — Dissolved in water, forms a useful 
lotion for cases in which desquamation is a most 
marked feature. (F.) 

Thymol:— In the following lotion, can be used 
freely : 

Thymolae, £i. 

Liq. Potassae, f 51. 

Aq. Laurocerasi, Oj. 

Apply daily. (Vn. ) 

An ointment of 10 per cent, and upward is also 
used. When one stronger than 20 per cent, is desired, 
the thymol should first be dissolved in alcohol. (F.) 

Carbolic Acid: — The following combination is to be 
preferred when the hair is thick, to be applied after 
washing with the green soap : 

Acid. Carbolici, 9i. 

Alcohol, seu. Aq. Cologniensis, ^iss. 

Glycerini, giiss. 

Ol. Limonis, ^iss. 



PITYRIASIS CAPITIS. 425 

A few drops of this mixture are applied here and there over the 
surface by means of an eye dropper, and rubbed in well with a 
stiff brush. The mixture may be scented if desired. Apply daily. 

(Vn.) 

Oleum Rusci Crudum: — Excellent as a lotion or 
pomade. The lotion is as follows : 

01. Rusci Crud., gtts. xv-3:iiss. 

Ol. Ricini pur., 3 j— 3 ii. 
Ol. Bergamot., 

Ol. Citronelli, aa. gtts. xv. 

^Sther. Sulphuric, Qii. 
Alcohol, Fort., q. s. ad. ^vii. 
Apply daily with brush. 

The pomade : 

Ol. Rusci Crud., ^ivss. 

Vaselini Alb., ifvss. 

Paraffini, ^ i. 

Ol. Bergamot, ^iss. 

Ol. Citronelli, 3 ii. 
Rub in scalp, with finger. 

These preparations will remove the scales and im- 
prove the functions of the glands to the extent, it is 
said, of restoring the hair (B. H.): 

Resorcin and Salicylic Acid: — May be combined 
advantageously in the proportions of 24 grains 
of each, and saponated glycerine 1 ounce. The 
base should be melted, the salicylic acid first in- 
corporated, then the resorcin at a lower temperature; 
this is said to form an excellent application, acting 
both as a soap and as an ointment. (Al.) 

Sulphur: — Unna recommends as the best line of 
treatment the application of an ointment made up 
of 1-3 parts of sulphur to 30 of simple ointment. 
The head should be first washed with Green Soap, 
and the ointment then applied by an attendant twice 



426 DIGEST OF EXTERNAL THERAPEUTICS. 

a week. When there is much falling of the hair from 
2—10 per cent, of Tincture Cantharides may be 
added. 

Pyrogallic Acid: — 1 drachm to the ounce has been 
used with great benefit, applied at night and washed 
off in the morning with a little soap spirit. Then fol- 
lows in most cases a little discoloration. 

In more chronic cases : 

Zinc. Carbonatis pur. , giv. 

Glycerini, 

Ol. Cadini, aa ,^i 

Cerati Galeni, ad. ^ viii. 

Rub firmly into surface night and morning; oftener if itching is 
present. (And.) 

The following is recommended by Vigier : 

Hydrarg. Sulphat. Flavse, grs. xlv. 

Vaselini, 3xv. 

Ess. I/imonis, gtt. xx. 

Keep in porcelain jar. Apply at night and wash off in the 
morning. 

Creosote: — Recommended by Tilbury Fox in the 
following formula : 

Creosoti, M xxx. 

Glycerini, giii. 

Aquct;, ^ v-viii. 

Borax:— 2 drachms to the ounce of glycerine is fre- 
quently serviceable. (Kp.) 



PITYRIASIS VERSICOLOR. 

Tilbury Fox recommends the following measures 
as being effective : 
A Hot Bath taken for 3 nights in succession, the skin 



PITYRIASIS VERSICOLOR. 427 

being vigorously scrubbed, either with cheap yellow 
soap, or preferably Sapo Viridis, friction of the skin 
being maintained with a flesh brush. ,The affected 
area is then moistened with Vinegar and water, or 
Dilute Acetic Acid, after which it is to be well 
sponged with a solution of Sodium Hyposulphite 
3i-^i. The eruption usually fades after the third 
bathing; should there be a recrudescence, it must be 
attacked with solution of Corrosive Sublimate, grs. 

i-ij-Ii. (Hy.) 

Vlemingckx's Solution:— Diluted from 3-6 times, 
forms an excellent application. 

Tr. Iodine: — Painted on the part often acts well. 

(F.) 

Sulphur Baths: — Combined with Mercurial Lo- 
tions, are used by McCall Anderson. 

Black Soap: — Is useful for scrubbing the skin in 
hospital practice, a substitute for which in private 
practice is the following : 

Hydrarg. Perchlor., 9j. 

Sapo. Virid., ^iij 

Spts. Rect., ^ii. 

Ol. Lavandulae, 9j. (And.) 

Scrub skin night and morning ; caution regarding 
absorption of mercury. (And.) Leloir modifies the 
above formula by adding one more ounce of green 
soap, and twice the quantity of rectified spts. (T. 
C, Vol. V.) 

The following is recommended by Brocq : 



Salicylic Acid, 


2-3 parts. 


Precipitated Sulphur, 


10-15 parts. 


Lanoline, 


70 parts. 


Vaseline, 


18 parts. 



The following combination, by Besnier, acts well : 



428 DIGEST OF EXTERNAL THERAPEUTICS. 



Resorcin, 




Salicylic Acid, 


aa grs. v-xlv 


Precipitated Sulphur, 


Jss. 


Eanoline, 




Vaseline, 




Lard, 


aa 3 vi. 



Sulphurous Acid (pure or dilute); Carbolic Acid 
(V2— 2 per cent, solutions); Hydroxylamine Hydro- 
chloride (1 grain with an ounce each of alcohol and 
glycerine); Hydrargyrum Sozoiodate (a 10 percent, 
solution in water); Quinine (5 per cent, ointment); 
Wilkinson's Ointment, and the other parasiticides 
employed in the treatment of ringworm of the body, 
are all well attested remedies. 

The underclothing should be cleansed frequently, 
and not worn after treatment until they have been 
thoroughly boiled in hot water. 



PLEURISY, ACUTE. 

Poultices; — Large, hot and frequently applied, are 
generally grateful to the patient. (Gn.) 

Laudanum: — May be poured on poultices, or Mor- 
phine administered hypodermically. 

Adhesive Plaster Straps: — Arranged so as to re- 
strain the respiratory movements, as in fracture of 
the ribs, will, if properly applied, afford much relief. 
The plasters should be about 2% inches w T ide and the 
application should be made after expiration. (Gn.) 

Ice Bags: — Advised by some, but the majority of 
patients find hot applications more grateful. (F.) 

Blisters: — May be employed in the earliest stage 
to limit inflammation, and later, in stage of effusion, 



PLEURISY, ACUTE. 429 

to promote absorption. In the latter instance they 
should be applied some little distance from the seat 
of dulness. (F.) 

Sinapisms: — Are often helpful; the following is rec- 
ommended : 

Pulv. Sinapis, ^ss. 

Pulv. Lini, ^viii. 

Aq. Bullientis., q. s. (Sn.) 

Guaiacol: — Useful in the stage of effusion to pro- 
mote absorption. 

Guaiacol., grs. xlv. 

Tr. Iodi, 

Glycerini, each 3 v. 

Paint over posterior portion of thorax. Reaction appears in 
about four hours. ( Sj . ) 

Olive Oil: — A recent method for dry pleurisy and 
pericarditis consists of the injection of sterilized 
olive oil, 15-45 minims, over the point of friction 
murmur. It is not painful. (Sj.) 

In the latter stages, little is gained by external ap- 
plications, except for relief of pain. 

Large effusions should be treated by Aspiration, the 
indications for which are : 

" 1. Distension and pressure dangerous to life. 

2. Subsidence of fever and other active symptoms, 
but no decrease in the effusion. 

Paracentesis is sometimes rapidly curative, as well 
as palliative ; therefore tap in delayed absorption, 
even if no urgent symptoms are present." (Gn.) 



PLEURODYNIA. 

(See Muscular Rheumatism.) 



430 DIGEST OF EXTERNAL THERAPEUTICS. 



PNEUMONIA— ACUTE, CROUPOUS. 

There is considerable diversity of opinion in regard 
to the utility of external therapeutic measures in this 
disease. " Pneumonia jacket," heat and cold, in vari- 
ous forms, are all advocated. Goodno, who recom- 
mends protecting the chest with a simple layer of 
flannel, says : " That as good results are claimed for 
all, it may be concluded that none are especially val- 
uable." The truth or error of such a conclusion is 
still to a certain extent an open question. 

Dry Cupping: — Applied to the chest is often of ser- 
vice in the early stages. After the application of half 
a dozen cups, a patient previously unable to lie down, 
owing to the dyspnoea, will assume the recumbent 
position and fall asleep. 

Sinapisms: — Are useful for the pleuritic pains. 

"Pneumonia Jackets:" — These are much in use, 
especially in England and in this country. They may 
either consist of loosely quilted cotton jackets or, 
what is preferable, a piece of oiled silk cut out 
so as to fit the chest. Over this a layer of 
cotton batting is placed ; the jacket is then applied, 
the cotton batting, of course, next to the skin. The 
jacket, or more correctly the layer of cotton and oiled 
silk, is pinned over the shoulders and down the front 
of the chest with safety pins. Before applying the 
jacket, a good many smear the cotton batting 
thickly with a mixture of Turpentine and Vaseline, 
which, acting as a mild counter-irritant, is generally 
grateful to the patient. 

Poultices: — Hot flaxseed meal poultices enveloping 



PNEUMONIA — ACUTE, CROUPOUS. 431 

the whole chest have, with good reason, gone out of 
use. Whatever good results they may have had they 
were more than compensated for the evils of inconve- 
nience of application, requiring, as they do, frequent 
changing, discomfort, disturbance, and exposure of 
the patient. Small poultices are, however, of benefit 
when applied over circumscribed are as for the relief of 
pleuritic pains. When the jacket is used, a small poul- 
tice over the surface of which laudanum may be poured 
for its anodyne effects, may be slipped underneath the 
edge and placed over the painful part, which is 
usually on the side and convenient of access. It 
should, however, not be lost sight of that if heat is 
too great between the shoulders it intensifies the con- 
striction of the arterioles. (See Chapman's Spinal 
Ice Bag Treatment under Paralysis.) 

Cold Applications: — These have lately been gaining 
favor. The method of Baruch is as follows: En- 
velop the chest in a suitably fitted linen or cotton 
jacket wet with cold water. The jacket should be 
removed and a fresh, dry one substituted whenever 
the temperaure falls to 100°, and removed if it rises ; 
in this way, it is claimed, all danger is averted. Dr. 
Mays, of Philadelphia, prefers to surround the 
affected area with ice bags wrapped in towels, but 
they are difficult to keep in position. 

Ice over the precordial region is recommended as a 
refrigerant and cardiac stimulant in children. (Jac.) 

Excellent results from the use of Cold Compresses 
are reported by Dr. W. F. Jackson, of Brockville, Ont. 
He claims lowering of temperature, quieting of the 
circulation, relief of pain, and promotion of general 
bodily comfort. Dr. T. I. Mays reports a death rate 
of 2.7 per cent, out of 74 cases in which cold water 
treatment had been tried. (T. 96.) 



432 DIGEST OF EXTERNAL THERAPEUTICS. 

To avoid venous stasis, patient's position may be 
changed every hour, and not permitted to remain 
long on back. (Sj.) 

The cold compresses used for adults cover the back 
and front of the chest ; they are wrung out in water 
at a temperature of 60°, and refreshed every half 
hour, according to case. A higher temperature may 
be used if there is much jactitation and excitability. 
Cold water may be first dashed in the face if there is 
much delirium. Not a little of the benefit of cold 
compresses is due to their tonic effect upon the nerve 
centres, and to relieving the cerebral congestion by 
dilating the surface capillaries. (T. 98.) 

Ice Cradling: — The following method is described 
by Dr. P. B. Smith (Brit. Med. Journ., May 11, '95). 
The patients were placed in bed and over the body 
and legs two large cradles were arranged extending 
from the shoulders to the feet. Six or eight small 
pails filled with ice were attached to the arches of the 
cradles. A thermometer was also attached to the 
upper part of the cradle, which was then covered 
with a blanket, then with a water proof, and lastly 
with the ordinary covering. The pails were kept 
filled with ice, and the temperature under the cradles 
of the ward and of the patient was taken every four 
hours. The temperature of the air under the blan- 
kets was also taken before the cradles were ar- 
ranged. This treament was maintained until the pa- 
tient's temperature became normal. Dr. Smith's re- 
ports say that the cases upon which this method was 
employed were those of acute sthenic pneumonia. 
Out of 108 cases treated by sponging and ice cradling, 
10 per cent. died. The patients, as a rule, were said 
to feel comfortable, but one or two complained of 



PNEUMONIA — ACUTE, CROUPOUS. 433 

cold feet. Dr. Smith concludes from the results of 
his investigations that ice cradling is suitable as a 
mild antipyretic treatment in sthenic cases. It is 
easily applied and not violent in its effects. 

Dry Heat: — Dr. C. W. Ingraham has adopted a 
method of applying heat by an apparatus for the cir- 
culation of hot water through coils of rubber tubing, 
so arranged as to cover the whole chest. (N. Y. Med. 
Journ., May 18, 1895.) Excellent results are claimed 
for this method, although its application appears to 
have been limited. 

Cold Baths: — In the case of children, the tub can be 
employed, but for adults compresses are preferable. 
When tubing is administered begin with a tempera- 
ture of 95°, and gradually lower according to indica- 
tions ; continue for about ten minutes, and repeat 
every three or four hours. (S. B.) 

Cold Packs:— Generally preferred by Jacobi, in infan- 
tile pneumonia, with hyperpyrexia. Wrap the child 
in a wet towel, and cover with a blanket. In urgent 
cases this may be replaced by another every two or 
five minutes. When frequent changes are undesirable 
the wet towel may remain and the surface rubbed 
with ice. If the temperature is reduced rapidly heat 
must be applied. Feeble and anaemic babies do not 
bear cold well. When the heart is weak and extrem- 
ities chilly, cold bathing is contra-indicated. (Jac. ) 

Hot Baths: — Also used in infantile pneumonia. 
They are indicated in cases with high fever; when 
the patient is feeble or anaemic, and when the circula- 
tion is poor, with cold surface and high rectal tem- 
perature a hot bath under these conditions will act 
beneficially. (Hit.) 

Tepid or Warm Packs: — With alcohol, or a tepid 

29 



434 DIGEST OF EXTERNAL THERAPEUTICS. 

bath, gradually cooled, with friction constantly ap- 
plied, may be employed in anaemic children. (Jac.) 

The general indications for the use of cold and heat 
in croupous pneumonia may be briefly summarized 
as follows : In robust persons with full strong pulse, 
with continued hyperpyrexia, cold may be employed ; 
in patients of a less vigorous constitution and in 
those who are feeble and anaemic employ heat, espe- 
cially when the surface is cold and heart weak, con- 
ditions which decidedly contra-indicate cold. Thus 
the employment of the powerful agents call for a 
careful study of each case. The " pneumonia jacket " 
with small anodyne poultices for the relief of pleur- 
itic pain are the methods generally adopted. 

Methyl Chloride: — Has been used to relieve local- 
ized pain ; applied along the course of the nearest 
nerve, is said to afford instant relief. (Sj.) 

Blisters: — Sometimes claimed of service, especially 
in delayed resolution. (Ty.) 

Oxygen Inhalations: — Are of undoubted value in 
relieving the dyspnoea. (Ty.) 

Artificial Serum: — Injections have been used after 
the method of Galvagni, a solution of chloride bicar- 
bonate of sodium being employed. The report is 
generally favorable, though, as yet, the treatment is 
too recent and the experiments too limited to war- 
rant any very definite conclusions or recommenda- 
tions. Subcutaneous injections are said to have ben- 
efited, while intravenous aggravated the condition. 

Serum Therapy: — Remarkable clinical results are 
claimed by both Klemperers, Fowlinsky and Em- 
merich, with anti-pnuemococci serum. The serum 
treatment has not been more generally adopted in 



POWDER STAINS. 435 

pneumonia on account of the difficulty of obtaining 
the serum from immunized rabbits. Whatever may- 
be the value of serum therapy, it has not yet passed 
beyond the stage of experimentation. 



POWDER STAINS. 

Stains due to gun powder may be removed, accord- 
ing to Shoemaker, by first washing with equal parts 
of Biniodide of Mercury and Distilled Water; this 
causes the spots to become red. Then apply Dilute 
Hydrochloric Acid and the red stains will disappear. 
(Sh.) 



PROCTITIS. 

The patient should be confined to bed and any scy- 
balae, if present, must be cleared away by injections. 

Cold Water Injections, and the application of Cold 
to the anus, will usually be sufficient for mild cases. 
(Gt.) 

Hot Water Injections:— May be employed in place 
of cold, and are generally more grateful. (Bt.) 

Anodyne Injections: — About 2 ounces of mucilage 
of starch, with a few drops of Laudanum (Tre.), or 
decoctions of Althea. (Al.) 

Suppositories of Iodoform, grs. v.; Ext. Bella- 
donna, gr. Ya f are very useful. (Tre.) 

Antiseptic Injections: — Are of great service, espe- 
cially if the disease is specific, viz : Solutions of Boric 
Acid, Hydrarg. Bichloride, 1—10,000 (not stronger); 
Carbolic Acid, 1-100. 



436 DIGEST OF EXTERNAL THERAPEUTICS. 

Nitrate of Silver: — If the disease does not yield, 
weak solutions of grs. ss-gi may be injected, increas- 
ing the strength later four or five times as indicated. 
(L. T.) A solution of 5 grs. to the ounce, painted on 
through the speculum, is recommended in chronic 
forms, or as an injection in the strength of grs. iii— ^i. 
When the disease is extensive the latter should be f ol- 
lowed by copious injections of warm water. Appli- 
cations as injections should not be made more fre- 
quently than every third day. (K.) 

Astringent Injections: — These are useful in chronic 
forms. In addition to nitrate of silver, the follow- 
ing are employed when the discharge is very fetid : 



Or, 



Liq. Bismuth, 


5ii- 


Gly cerate of Starch, 


5jjii. 


Liq. Carbon. Deterg., 


3™, 


Tr. Kramerise, 


£iv. 


Mucil. Amyli, 


ad. ^iv. 


% i night and morning. 





(Tre.) 



Inject %i night and morning. (Tre.) 

Other useful astringents are : Alum, gss-i-Oj; Tan- 
nin, 1—2 per cent, solution ; Zinc Sulphate, grs. vx— ^i; 
Infus. Hydrastis, 31-Oj. 



PROSTATE, HYPERTROPHY OF. 

Guard against exposure and sudden chilling, al- 
ways protect limbs and feet when arising to urinate 
at night. A warm and equable climate is of great 
benefit. Over-distension of bladder should never be 
permitted. Horseback riding and excesses of all 
kinds should be avoided. 

The passage every fifth day of a full-sized conical 



PROSTATE, HYPERTROPHY OF. 437 

steel sound or the local application to the prostatic 
urethra of a solution of Nitrate of Silver, 1—3 grs. to 
the ounce with a Keys-Ultzman capillary syringe, 
gives good results. (CI.) 

Catheterization: — Often necessary to remove resi- 
dual urine, especially when atony of the bladder ex- 
ists. It may be employed before retiring in order to 
give a better night's rest, and may also be required 
during the day. In some instances it will be neces- 
sary to use Mercier's catheter with one or two 
elbows, or an English catheter moulded to an exag- 
gerated curve by placing in hot water, then cooling 
in ice water ; quickly introduced with stylet removed, 
this will frequently succeed in entering the bladder. 
If cystitis exists the bladder should be washed out 
with an antiseptic solution. Catheters should receive 
strict antisepsis. (Cln.) 

Bottini's Galvano-Cautery Incision: — This method 
consists in burning one or more grooves through the 
obstructing portion of the prostate by the galvano- 
cautery. Freundenburg's modification of Bottini's 
incision renders the procedure thoroughly aseptic and 
entirely under the control of the operator. This in- 
strument is described as follows : " It consists of a shaft 
shaped like a lithotrite, provided with a platino-iridi- 
um blade, or a male shaft which is connected directly 
with a storage battery, or with a street alternating 
current of 104 volts, by means of the cautery trans- 
former, and controlled with an ampere meter, and 
concealed when the blade is closed within the female 
blade. The platino-iridium blade is exposed by turning 
the wheel attached to the Archimedian screw to the 
right, the scale on the exposed shaft behind the wheel 
exactly gauging the length the male blade is exposed 



438 DIGEST OF EXTERNAL THERAPEUTICS. 

or the length of the groove made in the prostatic 
tissues. The incisor is provided with a cooling appa- 
ratus, which runs through the entire length of the 
shaft, crossing at the beak and returning on the oppo- 
site side of the instrument. The entrance and exit of 
the water canals are directed downwards and in- 
wards. To one is attached a piece of rubber tubing, 
which supplies cold water from a reservoir and to the 
other a similar piece of tubing, which conveys the 
water to a receiver." 

Before operating it is very important to examine 
the bladder thoroughly with the cystoscope, and 
with Thompson's stone searcher, in order to ascer- 
tain whether or not a stone is present, and to deter- 
mine the relative size of the middle and lateral lobes 
of the prostatis. 

Excellent results are obtained from the Bottini- 
Freundenberg method. It is not, however, free from 
danger, and is contra-indicated when the kidneys are 
involved. Sepsis from opening a pocket of pus in the 
prostatic abscess and pulmonary thrombosis must be 
considered as possible dangers. When cystitis or pye- 
litis are present, both local and internal antiseptic 
medication should precede the operation. (The de- 
tails and technique of application are fully described 
by Dr. B. G. Carleton in the N. Y. Med. Times, Dec, 
1898.) 



PROSTATITIS. 

ACUTE PROSTATITIS: 

Rest in Bed, Hot Sitz or General Baths, Fomenta- 
tions to perineum, Rectal Douches of hot or cold 



PROSTATITIS. 439 

water, injected against the prostate by means of a 
rectal psychophore, or by enemata of from two to 
four quarts of water, several times a day are effective 
measures. (Cln.) 

Anodyne suppositories, containing Belladonna, 
Hyoscyamus, or Opium, such as the following : 

Ext. Opii Aqueos., gr. j. 

Ext. Hyoscyami, gr. ss. 

Ol. Cocois, q s. 

Or, 

Ext. Belladonnae, gr. %. (Sn.) 

Ol Cocois, q. s. 

Leeches: — To the perineum are recommended by 
some authorities when there is much throbbing and 
pain. (Al.) 

Catheterization: — When there is retention, the urine 
must be drawn, instrumentation being preceded by a 
douche of a 2 per cent, solution of Cocaine. 

Incision: — When an abscess forms it must be opened 
in the perineum in order to avoid ischio-rectal fis- 
tula. If it becomes necessary open the abscess in 
the rectum, make a punctured incision and keep the 
rectum aseptic as much as possible by frequent Car- 
bolic Douches. After antiseptic douching the cavity 
of the abscess may be distended with a warm emul- 
sion of Iodoform in vaseline in the strength of 10 per 
cent., which will give excellent results. If an abscess 
open into the urethra, the canal should be irrigated 
twice a day with a saturated solution of Boric Acid 
or a solution of Nitrate of Silver, 1-2000. (Cln.) 

Cold Sitz Baths: — Of twenty to thirty minutes, 
daily at bed times. 

Suppositories of Iodoform or Ichthyol, containing 
each about 2 grains, have proved beneficial. (Cln.) 



440 DIGEST OF EXTERNAL THERAPEUTICS. 

Cleanse the rectum first with a douche before in- 
serting. 

Tannate of Glycerine: — Applied to the inflamed 
point in the urethral canal by means of a deep ure- 
thral syringe is said to have good effect. (Al.) 

Massage of the Prostate :— The patient should be 
placed in the dorsal position with the limbs slightly 
flexed or in the knee and elbow position. The finger 
of the operator, protected by a long rubber tip and 
anointed with vaseline, is inserted into the rectum. 
The diseased gland is massed from right to left and 
the reverse. The tip of the finger should also be em- 
ployed to press the gland forward toward the sym- 
physes, and a forward and backward massage move- 
ment made. This procedure should be continued 
from two to five minutes and may be repeated every 
fifth day. In some cases it is advisable to introduce 
a full sized steel sound into the urethra, and retain it 
during massage. Massage by Feleke's or Swinburne's 
instruments is not advised. (Cln.) 

Cantharidal Collodion: — Is advised by some writers; 
one side of the perineum is painted up to the raphe and 
the patient is kept in bed ; when the part has healed 
the other side is painted. The anus and scrotum 
must be protected. (CI.) 

The Rectal Psychrophore or Kemp's rectal cooler 
are also of service. 

CHRONIC PROSTATITIS: 

Rest in the recumbent position and evacuation of 
the bow^els daily by Enema are important factors of 
treatment. 

The passage of Cold Steel Sounds is very effica- 
cious; a full-sized sound should be selected and passed 



PRURIGO. 441 

with the utmost gentleness and ease, or it will be ar- 
rested by the compressor urethras, which is usually in 
a condition of spasmodic contraction. The sound 
should be passed every five or eight days. In some 
cases a Carleton's or Kollman's antero-posterior ure- 
thra dilator may be used. (CI.) 

The Psychrophore: — As some attribute the good re- 
sults from the use of the sound to the cold, the pass- 
age of a hollow instrument through which cold 
water is caused to flow, left in situ for about five 
minutes, is also employed. (CI.) 

Nitrate of Silver: — 2-3 drops of a solution, gr. 
i— x-^i, applied by means of the Key's-Ultzman capil- 
lary syringe, may be used when the mucous membrane 
is seriously affected, as shown by the discharge of 
round masses from the lacunas of the glands. (CI.) 

In many cases the application of this remedy to the 
prostatic urethra will be attended with benefit. For 
strong solutions will cause intense reaction. The 
solutions should be accurately placed in the prostatic 
portion of the urethra. This may be accomplished 
by introducing a catheter and thus ascertaining the 
point at which the urine begins to flow, with the 
length of the urethra known there will be no diffi- 
culty in making the application. The solutions 
should be generally increased up to 5 per cent, and 
should not be applied more frequently than once in 
five days. 



PRURIGO. 

The first aim of treatment is to improve the hy- 
gienic surroundings of the patient and to employ lib- 
erally soap, water, and clean clothing. 



442 DIGEST OF EXTERNAL THERAPEUTICS. 

Pilocarpine Muriate: — On account of its action 
on the sweat glands, has a powerful effect on the gen- 
eral condition and may be regarded as a reliable 
remedy. It may be administered hypodermically, 
but in small doses, for fear of collapse. (B. H.) 

Baths: — Plain or alkaline, are very generally em- 
ployed, followed by ointments or lotions, viz: 

Unna's ointment acts favorably. It is composed 
Zinc Oxide Ointment, 100 parts ; Carbolic Acid, 5 
parts; Corrosive Sublimate, V^— 1 ^ part. 

Wilkinson's Ointment: — Hebra recommends the 
following modification of Wilkinson's ointment (in 
which sulphur is the main ingredient): 

Flor. Sulphuris, 

Ol. Cadini., aa. ^ vj. 

Sap. Vir., 

Adipis, aa Oj. 

Cretse, %iv. (And.) 

Anderson recommends Plain, Warm, Vapor, or 
Turkish Baths, followed by friction, and the use of 
the following ointment : 

Sulphuris, 

Glycerini (Price's), 

Ol. Rusci, aa gvi. 

Ung. Rumicis, ^ii. 

Vlemingckx's Solution: — Followed by hot baths, 
are also advised. (Hy.) 

The following other remedies may be mentioned as 
effective : 

Tar Ointment, Sodium Thiophene Sulphonate, So- 
dium Sulphophenate (5—10 per cent, ointment) ; 
Hebra' s Soap Treatment, as for eczema, all consti- 
tute useful remedial measures. 

Naphthol: — 2—5 per cent, solution, according to 



PRURITUS. 443 

age, rubbed in every night in conjunction with a bath 
of naphthol soap every second night. (Ja.) 

Tumenol: — A 10 per cent, solution made with 
equal parts of alcohol, glycerine and water. (Al.) 



PRURITUS. 

External treatment, though of little effect in curing, 
is of great benefit in relieving. When the disease 
covers the whole surface of the body, baths will be 
found of service. Linen underwear, over which flannel 
can be worn, agrees with some, while others prefer silk. 
A great number of remedies, of which the following 
are the most important, are employed for the relief 
of this intractable affection : 

Carbolic Acid: — One of the most effective applica- 
tions, it generally be tried first. It may be employed 
in strengths varying from 5—20 grains to the ounce, 
or in the following combinations : 

Carbolic Acid, 20 parts. 

Glycerine, 75 parts. 

Alcohol, 25 parts. 

Distilled Water, 300 parts. 

1-4 tablespoonfuls in a tumbler of hot water; bathe parts. 

(T.98.) 

Combined with creoline, it will be found useful in 
the f ollowing proportions : 

Carbolic Acid, 2 parts. 

Creolini, 3 parts. 

Cologne Water, 100 parts. (Hy.) 

A solution in Alcohol, 1-2 drachms to the ounce, is 
recommended. Mop the skin gently, but do not rub 
in. A spray of the strength of half an ounce, to wa- 



444 DIGEST OF EXTERNAL THERAPEUTICS. 

ter 1 pint, and glycerine 1 ounce, with 5—10 minims 
of oil of peppermint added, is also useful. (Ja.) 

The fact that the skin of some persons is much 
more sensitive and liable to irritation than others 
must be taken into consideration before employing 
the stronger solutions. An ointment being sometimes 
preferable, the following will be found useful: 

Acid. Carbolici, grs. xv-xx. 

Ung. Zinc. Oxidi, ^ i. 

Menthol: — Used in various strengths ; an alcoholic 
solution containing 10 per cent, acts well. (F.) In 
severe forms a solution of 50 grains to the ounce of 
olive oil has proved effective. (Al.) Or combined with 
cocaine, viz : 



Menthol, 


3*- 


Cocaine Hydrochlorate, 


grs. xx 


Alcohol, 


|i. 


Water, 


Si- 



Cocaine: — 2 parts with 100 of flexible collodion, or 
a solution of 20 per cent, with 5 of glycerine. (F.) 

Brucine: — Acts somewhat like cocaine and has 
been satisfactorily employed in 20 per cent, solutions, 

(F.) 

Chloroform: — 1 drachm ; olive oil, 1 drachm; will 
allay the itching of urticaria and pruritus (F.), or gi 
with 1 pint of alcohol. (B. H.) 

Ichthyol: — Will prove useful, though it makes a dis- 
agreeable application ; the following is a method of- 
application : 

Ichthyol, io parts. 

Spirits of Wine, 40 parts. 

Ether, 40 parts. (T. 97. ) 

Bulkley has used : 

Ichthyoli, 3*- 
Ung. Picis, Si- 
Zinc. Oxidi, 3"- 
Ung. Aq. Rosse, ^iii. 



PRURITUS. 445 

Or, 

Ichthyol, 
01. Cadini, 

Ol. Gossypii, aa, £i. 

Use diluted with oil. 

Camphor: — Useful in the form of the spirits, pow- 
der or ointment, or combined with chloral by tritura- 
tion of equal parts, forming the well known glycerine 
like mixture. An ointment is composed as follows : 

Camphor. , 

Chloral, aa ^i. 

Ung. Aq. Rosas, %i. 

These preparations should not be used on the broken skin. 

(Vn.) 

It may also be combined effectively with borax, as 
follows : 



Spts. Camph., 


^ss. 


Boracis, 


3ij- 


Glycerini, 


lij. 


Aquae, 


Svj. 


To be well shaken before applying. 


(A. C. S.,.8, 77.) 



It may also be mixed with potassium sulphuret in 
the following proportions : 

Potass. Sulphuret., 3 n j« 

Spts. Camphor, f ^ss. 

Glycerini, f ^i. 

Aq. Fort., q. s. ad. f ^vj. 

Apply by the medium of a saturated strip of lint. 

Opium: — In the following ointment: Opium, 8 
grains; creosote, 10 drops; vaseline, 2 ounces. (Ga.) 
Or in the form of morphine in the proportion of 1 
grain to the ounce, added to the two compound cam- 
phor lotions above, may be employed when anodyne 
lotions are desired. (Hy.) 



446 DIGEST OF EXTERNAL THERAPEUTICS. 

Pilocarpine: — Simon has successfully employed this 
remedy hypodermically in doses of -J- of a grain of the 
muriate. (Hy.) 

Alkaline Lotions: — Sod. Bicarb., 31-OI; Borax, 
sat. solution in rose water; Lime Water (pure), or 
in the following is especially useful for the itching of 
eczema and other inflammatory conditions of the 
skin, also in senile pruritus : 

Liq. Calcis, 3 n j- 

Creosoti, M. x. 

Pulv. Zinc. Carb. (Impure), Ji. 

Glycerini vel. Olei Olivae, 3 iij. (Sm. ) 

Losophen: — 1-2 per cent, in a mixture of 3 parts of 
alcohol and 1 part of water, apply two or three 
times a day. In some cases this will prove irritating ; 
an ointment of 1—3 per cent, is also used. (F.) 

The following is recommended in dry itching in- 
flammatory affections of the skin : 

Talc, 

Powdered Starch, each 5 parts. 

Glycerine, 20 parts. 

Lead Water, 100 parts. 

This is to be diluted with twice the volume of water, shaken and 
applied to the skin and allowed to dry. When the skin is broken, 
half the lead water may be replaced by a 1 per cent, solution of 
boric acid. The lotion is contra-indicated when there is a fluid dis- 
charge. (T. 98.) 

Among some of the useful powders are the follow- 
ing: 

Talc, 

Oxide of Zinc, each 5 parts. 

Salicylate of Bismuth, 10 parts. 

Rice Starch, 90 parts. 

Borax, 2 parts. 

Talc, 10 parts. 

Oxide of Zinc, 30 parts. 

Rice Starch, 60 parts. 

(T. C. Vol. 5.) 



PRURITUS. 447 

Medicated Baths: — These will at times afford re- 
lief; the following will be found of service : 

Sodium bicarbonate, ^viij-^x ; water, 30 gallons ; 
nitric or hydrochloric acid, %i; water, 30 gallons. 
Starch baths, followed by sponging with aromatic 
vinegar 250 parts, and carbolic acid 5 parts. Sul- 
phur baths also are sometimes useful. After the bath 
the patient should be dried by wrapping in warm 
sheets, followed by a vigorous patting of the skin, 
anointing same with some bland oil and powdering 
with starch. 

Acid Lotions: — Viz: Vinegar, Lemon Juice (pure 
or diluted), and solutions of Dilute Hydrochloric 
Acid are said to relieve the itching of urticaria. 

Tannin: — Squibb's formula is as follows : 



Acid. Tannici, 






9j- 


Glycerini, 








Spts. Vini Rect., 






aa ^ss. 


Aq. Destill., 






ad. :§iv 


Apply morning and evening 


on 


a rag. 





The following are among the almost endless num- 
ber of remedies which have been advised for this con- 
dition : 

/9-Naphthol., 9i. 

Retinol, 

Sapo. Mollis, aa grs. cc. 

Pulv. Cretae Praeparat., £)ii. 

Essence of Wintergreen, i part. 

Thymol, 2 parts. 

Resorcin, 4 parts. 

Cologne Water, ioo parts. 

Mercuric Bichloride: — Grs. ss— §i. 
Burow's Liquor:— (See Appendix II.) 
Resorcin: — Grs.x -xx— 3i. 



448 DIGEST OF EXTERNAL THERAPEUTICS. 

Tumenol, a 10 per cent, alcoholic or aqueous so- 
lution. Also lotions of Hamamelis, dilute Aqua 
Ammonia, Tar Water, and Goulard's Solution. 

Liq. Picis Alkalinus:— Picis liq., §ii ; potass, caust., 
^i ; aq., gv. Dissolve the potash in water and gradu- 
ally add to the tar with rubbing in a mortar. Dilute 
for use in the proportion of 1—2 drachms to a pint 
of water, gradually increasing the strength. 

PRURITUS ANI. 

Removal of cause when it can be ascertained, such 
as haemorrhoids, fissure, eczema, ulcer, polypi, ascar- 
ides, etc., is the first essential of treatment. Many 
cases, however, are unattended with any discernible 
pathological change, and palliative treatment is nec- 
essary. Applications may be made in the form of 
lotions or ointments ; as a rule, the latter are pre- 
ferable. Of the numerous remedies for this condition 
the following are worthy of mention. 

Hot Water: — Applied as hot as can be tolerated 
with soft cloth or by sitting over a pail of hot water 
and sopping the parts; dry gently by patting the 
skin, and dust with starch powder. 

Carbolic Acid: — One of the most effective agents. 

Acid. Carbolic, §ss. 

Glycerini, % i. 

Aq, DestilL, ^iii. 
Dilute if too strong; apply at night. (K. ) 

Alum and Zinc Sulphate: — Equal parts of each 
placed in an earthen vessel and heated until they be- 
come a hard mass ; of this half a drachm is powdered 
in a little water and thrown into the rectum every 



PRURITUS. 449 

night; in a few minutes it will dispel the itching, and 
will succeed when other drugs have failed. It is espe- 
cially indicated when there is engorgement of the 
hemorrhoidal veins. (Al.) 

Campho-Phenique: — Equal parts with Zinc Oint- 
ment, is highly praised (Al.), or si to water ^i after 
bathing in very hot water. (Mc.) Another useful 
formula is : 

Campho-Phenique, gi. 

Losophen, grs. xx. 

Cosmoline, %i. (T. 98.) 

Salicylic Acid: — 5v-^i, will often afford great relief. 
(Al.) 

Cocaine and Menthol: — Combinations are effective. 
(See Pruritus.) 

Nitrate of Silver: — A solution of grs. xvi. in 
Nitrous Ether (Ja.), or grs. xx; water, gi (Gt.), 
painted on will cause pain, but will afford immediate 
relief. 

Bulkley's Antipruritic Powder is very satisfactory ; 
it is composed of 1 drachm each of Camphor and 
Chloral, rubbed together until liquified, then mixed 
with 1 ounce of starch. 

Tr. Sapo. Vir.: — When there is thickening of the 
skin from effusion this is indicated. 

The following combination also acts well : 

Sapo. Virid., 
01. Cadini, 
Alchohol., p. e. 
This is most effective, at the same time more disagreeable than 
the green soap alone; it should be applied once a day. 

Applications of green soap should be followed by 
soothing ointments. (K.) 

Brocq employs as a soothing ointment Zinc Oxide 
and Vaseline, followed by this powder : 
30 



450 DIGEST OF EXTERNAL THERAPEUTICS. 

Powdered Camphor, 2 parts. 

Zinc Oxide, 30 parts. 

Bismuth Subnitrate, 30 parts. 

Chalk, 40 parts. (T. 98. ) 

Lead Acetate:— The folio wing is used at St. Mark's 
Hospital, London : 

Liq. Plumbi Subacetate, 1 part. , 

Fresh Milk, 7 parts. 

Add the milk to the lard by degrees, at the same stirring; apply 
on cotton and retain in situ. (T. 98.) 

Collodion: — May be painted on as a protective 
when eczema and excoriations are frequent. 

Tar Ointments: — These are generally soothing and 
are indicated when eczema exists. 

The following are suggested, Ung. Picis painted on 
(T. 98.), or: 

Ung. Picis, 3;iii. 

Ung. Belladonnse, gii. 

Tr. Aconiti Rad., gss. 

Zinc. Oxidi, gi. 

Aq. Rosae, ^iii. (Mc. ) 

Tr. Iodine (Churchill's):— A painful but very effect- 
ive remedy. (Gt.) 
The following is recommended, to be injected daily: 

Fid. Ext. Hamamelidis, ^i. 

Ext. Ergot., ^ii. 

Ext. Hydrastis, gii. 

Tr. Benzoin, Comp., gii. 

Ol. Olivae Carbolat., (5 per cent. Carbolic 
Acid), gi. 

Shake well before using; 1-2 drachms for injection. (B. H.) 

An ointment of Dr. I. Y. Shoemaker's is : 

Sulphur Praecipitat., 9i. 

/5-Naphthol., grs. x. 

Morphise Sulph., gr. ss. 

Bismuth. Subnitrat., gss. 

Ung. Zinc. Oxid., ^ss. (Sh.) 



PRURITUS. 451 

Two formulas commended by Kelsey for use in ob- 
stinate cases are as follows : 

Liq. Carbonis Deterg. (Wright's), 

Glycerini, aa, ^i. 
Pulv. Zinc. Oxidi, 

Calamin. Prseparat., aa ^ss. 
Pulv. Sulph. Prsecipit., gss. 

Aq. Destill., ad. ^vjr 
To be painted on once or twice a day and allowed to dry. 

Sod. Biborat. 3ii- 

Morph. Sulph., grs. xvi. 

Acid. Hydrocyanic, Dil., gss. 

Glycerini, ^\i. 

Aq. Destill., ad. gviii. 
Apply 4 or 5 times in twenty-four hours. 

Borax: — Forms an excellent soothing application ; 
the powder dusted on the raw surfaces, kept sepa- 
rated by soft gauze, is used with good effect when 
moist eczema is the cause, a condition in which mild 
dry dressings are indicated. (G.t.) In other cases a 
saturated solution acts well. 

Dilute Sulphurous Acid — After cleansing the parts 
with soap suds this is said to afford quick relief in 
cases of eczema marginatum. (Gt.) 

Suppositories containing Belladonna, Cocaine, or 
Creosote give relief in cases where the parts are ex- 
coriated ; in this condition Menthol, Peppermint, 
and Chloral can not be employed. (Ja.) 

Forcible Divulsion: — When no local cause can be 
detected this measure has given satisfactory results 
(Gt.) in conjunction with removal of redundant skin 
by cutting and scraping ; it is recommended in cases 
which have resisted all other means. (T. 98.) 

PRURITUS SCROTI: 
Many of the remedies mentioned under the general 



452 DIGEST OF EXTERNAL THERAPEUTICS. 

head of pruritis are applicable to the disorder in this 
locality. In addition the following have proved sat- 
isfactory : 

Picric Acid: — 1-5 parts-1000, has succeeded when 
other applications have failed. 

Phenol: — 20 parts, glycerine 75 parts, alcohol 25 
parts, and water, 300 parts ; one part of this mixture 
is diluted with 4 of water and applied by means of 
saturated gauze. (T. 97.) 

Pyroligneous Acid: — 1 part to 30 of water or gly- 
cerine, or an ointment gradually increased in strength, 
is recommended by Piffard. 

PRURITUS VULVJB: 

Washing the parts with soap and water, then with 
a Sublimate Solution, following with applications of 
Cabolized Vaseline, 3-5 per cent., often proves suc- 
cessful. (T. 97.) 

Hot Water Sponging: — Using the water hot as it 
can be borne is excellent and should be tried in all 
cases. (Yn.) 

Nitrate of Silver: — A 2 per cent, solution is highly 
effective. 

The following method is recommended : Administer 
a vaginal injection every night of a solution of Lysol, 
followed by one of Boiled Water, and lastly by one 
of Sublimate. Wash the vulva with care and intro- 
duce between the labia a fold of muslin wet with a 
solution of Tannin ^ss-Oj. Excoriations may be 
touched with Nitrate of Silver. (T. 96.) 

Cocaine Hydrochlorate: — May be employed with 
good effect when the affection appears to start from 
the clitoris and is attended with nervous crises : 



PRURITUS. 453 

Cocaine Hydrochlor. , gi. 

Acid. Boric, giii. 

Dust on the clitoris and underlying parts; instant but only tem- 
porary relief will be obtained. 

Tannaform: — 1 part; starch, 4 parts, for diabetic 
pruritus. (F.) 

The following are useful applied with saturated 
compresses: 

Fid. Ext. Grindeliae, ^ss. 

Creolini, ^ii. 

Aquae, q. s. ad. ^v. 

Or, 

Potass. Bicarb., £ii. 

Aquae, Oj. 

Veratria' — In the proportion of 3 grains to the 
ounce of lard, is recommended by Cheron. (Hy.) 

Hydrocyanic Acid: — Used in severe cases, but with 
caution, and never where the skin is abraded, viz: 



Acid. Hydrocyanic, Dil., 


Jii. 


Acid. Boric, 


3*. 


Aq. Rosae, 


1 viii 


Bismuth. Subnit., 


3ii. 


Acid. Hydrocyanic, Dilut., 


3*- 


Mist. Amygdalae, 


giv. 



(And.) 

Emollient poultices, such as fresh Almond Meal, 
sprinkled with Boric Acid, will prove soothing; also 
the following lotion painted on parts : 

Sodium Sulphite, 5*- 

Glycerine, %i. 

Water, 3iv. (B. H.) 

Though ointments are rarely used, the following 
may occasionally prove of service : 

Hydrarg. Chlorid. Mitis, 

Ext. Belladonnae, aa ^i. 

Ung. Aq. Rosae, §i. 



454 DIGEST OF EXTERNAL THERAPEUTICS. 

Injections of Zinc. Sulph., grs. v-x— §i, and Bichlor- 
ide of Mercury, 1-4000, used on alternate days, with 
bathing of the external genitals once or twice daily 
with Eichoff's Sublimate Soap, constitutes a useful 
adjuvant to any mode of treatment. 



PSORIASIS. 

Cleanliness of person and clothing should first re- 
ceive strict attention. All causes tending to depress 
vitality, as excesses, overwork, relaxing climate, or 
other drains upon the system, should, if possible, be 
eliminated. Local mesaures are of prime importance, 
and are of two classes, first, those used to remove 
the scales, and so prepare the way for the second, 
which includes those exercising a directly curative 
effect upon the diseased skin, and so preventing re- 
newal of the scales. 

For removal of the scales the following methods 
are efficacious: 

Alkaline Baths, Wet Packing, Inunctions (with oil, 
vaseline, fat, soft soap, and even caustics), and a six 
percent, solution of Salicylic Acid in spirit. The fat 
requires to be well rubbed in. Many cases get well with 
one of the above methods alone if persevered in. Con- 
tinuous Baths in tepid water have been successful. 
(Ck) Daily Hot Baths and the use of soap and a nail 
brush should be employed in all cases, especially 
when the disease is wide-spread. The following 
alkaline bath may be resorted to and patient al- 
lowed to soak in it for twenty minutes, after which 
scales may be rubbed off : 

Bicarbonate of Soda, gii-giij. 

Water, 30 gallons, at temp, of 95 ° to ioo° F. 



psoriasis. 455 

Much depends upon the thoroughness with which 
the scales are removed. 

Sapo- Mollis (Potash Soap, Black Soap): — Rubbed 
night and morning and washed off as seldom as pos- 
sible ; highly praised by Hebra. (Hb.) 

Mercurial Ointments: — These are useful when only 
mild stimulants can be tolerated, viz: Hydrarg. 
Ammon. grs. x, vaseline ^ii-^i, or Hydrarg. Oxid. 
Flav. in the same strength, or these two mercurial 
ointments combined, or Ung. Hydrarg. Nitrat., more 
or less diluted, or Hydrarg. Biniodid. grs. iii— x to the 
ounce; the latter being a stronger stimulant. (Ck.) 

Chrysarobin: — This is the best application, espe- 
cially when it is desired to remove the patches rap- 
idly. An ointment of half a drachm to a drachm to 
the ounce may be employed, though it is better in the 
strength of about 5 per cent. Its activity is increased 
by the addition of salicylic acid (3 per cent.). 

A paint which has been markedly successful is : 

Chrysarobin, Si- 

Acid. Salicylic, 3*- 

Liq. Gutta Percha, gi. (Kp.) 

This remedy has the great objection of staining 
everything with which it comes in contact, dying the 
hair orange yellow, and ruining all clothing. It 
should never be applied on the face or scalp,- on ac- 
count of the dermatitis to which it may give rise, and 
the danger of violent conjunctivitis should any find 
its way into the eyes. 

The following solution avoids the smearing effect 
of an ointment : 



Ck.) 



Chrysarobini, 


3i- 


Collodii, 


Si. 


J^ther et Alcohol., 


aa q. s 



456 DIGEST OF EXTERNAL THERAPEUTICS. 

Rub the chrysarobin with the alcohol and ether, 
and add the collodion. It will result in an emulsion, 
which should be shaken before using and applied 
with a brush after the removal of the scabs. In gen- 
eral attacks Unna's Compound Chrysarobin Oint- 
ment (chrysarobin 5 parts, salicylic acid 2 parts, 
icthyol 8 parts, and vaseline 90 parts) is effective and 
speedy; it should be rubbed in after a bath. If 
chrysarobin produces too great a reaction it should 
be discontinued, and starch, vaseline, or an alkaline 
wash substituted. It stains the healthy skin a deep 
mahogany, and leaves the patches white; it should, 
therefore, be continued until the patches are affected 
in the same way. 

These effects may be avoided by using Auspitz's 
method, viz : 

Dissolve gutta percha si in chloroform sx, to this 
add si of chrysarobin, which solution, after the scales 
are removed, is painted on and forms a film. It is re- 
newed every two or three days. 

Besnier's modification of the above is to paint on 
a solution of chrysarobin in chloroform, and then 
cover it with the chloroform and gutta percha var- 
nish. Both methods are equally efficacious, and are 
superior to Pick's plan. (Ck.) 

Pyrogallic Acid: — This remedy stands next to the 
preceding in importance. It stains everything black, 
and, on account of its poisonous action by absorp- 
tion, is not suited to application over extensive sur- 
faces. Its action is less inflammatory than that of 
chrysarobin. The strength of its application is from 
a drachm to the ounce or weaker. (Vn.) The follow- 
ing combination has been productive of good results 
in cases which have resisted other treatment : Pyro- 



psoriasis. 457 

gallic acid, salicylic acid and ichthyol, each 3 parts, 
and olive oil and lanoline, each 10 parts. (T. 97.) 

Tar: — Has been found useful in various forms, and 
acts well when there is much itching. Crocker rec- 
ommends Ol. Cadini, ^ss to the ounce, as ointments, 
or as lotions dissolved in spirits with or without soft 
soap, equal parts of each, as Hebra recommends, or, 
Liq. Carbonis Detergens, M x— 3i and upward. He 
speaks also of tar baths as being useful remedies. 

The following is also a convenient mode of apply- 
ing this remedy : 

01. Rusci, 50 parts. 

Ether, 

Alcohol, each 75 parts. 

Filter and add oil of lavender, 2 parts, rub in at 
night, and wash off in the morning. The patient 
should sleep in a flannel gown. (Kap.) 

Thymol: — Introduced some years ago by Crocker, 
forms a pleasant and suitable application for the 
face, being more cleanly and of less offensive odor 
than the aforementioned remedies. An ointment 
may be used in the strength of grs. xv-3iii to the 
ounce, or as a lotion as follows : 

Thymol, 3i. 

Liq. Potassae, ^i. 

Glycerine, 5 SS - 

Elderflower Water, gviij. (Ck.) 

Naphthol: — This remedy is of equal efficacy with 
thymol. Kaposi recommends it in the strength of 
80 grains to the ounce. A soap containing 2 
drachms of the remedy to the ounce of green soap 
has been found to act well in cleansing the scalp, and 
an ointment of naphthol 3i, lard %i, is useful for re- 



458 DIGEST OF EXTERNAL THERAPEUTICS. 

moving the scales from the body. If used over an ex- 
tensive surface it may induce toxic symptoms. It 
may, however, be regarded as an excellent remedy 
when for any reason chrysarobin or pyrogallic acid 
cannot be used. (Al.) 

Sulphur: — Hebra's modification of Wilkinson's 
ointment often proves effective; the formula is as 
follows: Sulphur sub., ol. cadini, aa ^ss; sapo vir., 
adipis, aa^j ; cretae prasparat.,3jss. The ointment of 
tar and sulphur may also be used combined in the 
proportion of a drachm of the former to an ounce 
of the latter. (Guy's Hospital.) 

An ointment of sulphur (10—30 grains to the ounce) 
may be applied to the scalp, the strength depending 
upon the irritabilit}^ of the part. (T. 98.) Vlem- 
ingckx's solution (See Acne) is also of service. 

Among other remedies may be mentioned Nitrate 
of Mercury Ointment (F.); Solutions of Nitrate of 
Silver Oij— §i), recommended by Fox in chronic cases 
(B.); Gallacetophenone, 10 per cent.; Ichthyol, 5-20 
percent.; Resorcin, 5-20 per cent. (B. H.); Anthra- 
robin, the action of which is analogous to that of 
chrysarobin, and Turpentine. This last is a power- 
ful, penetrating stimulant, and has been employed in 
a large number of cases with gratifying success. It 
is cleanly, but the odor is a drawback. It can be 
used undiluted (in which case the skin is smeared 
with vaseline to prevent dessication) or pure, com- 
bined with olive oil in the proportion of turpentine 
^i to ol. olivas 3vij, and upward. (Ck.) 

For a base of ointment, lard, or vaseline, combined 
advantageously with 10-40 per cent, of lanoline, are 
most frequently employed. If a plaster is desired, use 
Unna's paste. 



PYORRHCEA ALVEOLARIS. 459 

India Rubber Underwear: — Is recommended by 
Crocker to be worn continuously for twelve hours 
or more and changed night and morning. The effect, 
he claims, is excellent, especially if the skin becomes 
moist and macerated. 



PYORRHCEA ALVEOLARIS. 

Carbolic Acid: — The persistent application of the 
crystals will cure this affection. 

Hydronaphthol: — Grs. xvi. ; alcohol, si; water, gi; 
teaspoonful to half a pint of water may be used freely 
with good effect as a mouth wash. (Al.) 

Menthol useful as an anodyne and antiseptic. (F.) 

Pyrozone: — 2-5 per cent, solution in ether, has been 
found a very effective stimulating and caustic appli- 
cation, especially serviceable in checking suppura- 
tion. (F.) 



RABIES. 

Immediate measures for the elimination of the poi- 
son from the wound should be employed, viz : 

Suction: — The patient should immediately suck the 
wound; if he is unable to do so himself, a second per- 
son may do so for him, though it is not without 
danger, owing to possible abrasions of the mouth. 
The mouth should be rinsed immediately. 

Cauterization:— Stands next in availability. The 
Actual Cautery should be freely applied ; red hot iron, 
poker, or any iron article. The Paquelin or galvanic 



460 DIGEST OF EXTERNAL THERAPEUTICS. 

cautery should be used if convenient, but the chances 
are these instrument will seldom be accessible. The 
pain of the actual cautery is not more severe than min- 
eral eschar otics. It should always be preferred, but in 
its absence Nitrate of Silver, the stick thoroughly ap- 
plied, or Caustic Soda may be used. It is claimed 
that the former is especially effective. Carbolic Acid, 
pure, or Corrosive Sublimate, 1-500-1000 may be 
used as substitutes, but only when the cautery is not 
available. (Ty.) 

Excision of the wound: — Is recommended as a par- 
amount necessity by some writers. (Hy.) As it is 
claimed that the instrument used may become in- 
fected by the virus from the wound, caution is neces- 
sary. 

Pasteur's Attenuated Virus: — This treatment can 
only be carried out at a Pasteur institute, one of which 
is situated in New York. A careful examination of the 
results of this method by exact and conscientious ob- 
servers show it to be an efficient agent in saving life. 

For the paroxysms : Chloroform Inhalations; sub- 
cutaneous injections of Morphia in full doses; 
Curare, in doses of y^-J- grains ; Ethyl Bromide in 
doses up to a drachm, both subcutaneously, or Amyl 
Nitrite inhalation should also be tried. (B.) 



RANULA. 

Iodine: — A few drops injected into the sac, usually 
effects cure. (H.) 

Chromic Acid: — After evacuation and washing out 
of cavity the saturated solution may be freely ap- 
plied. (Sm.) 



RECTUM AND ANUS, PROLAPSUS OF. 461 

Nitrate of Silver: — The crayon after removal of a 
portion of the sac. 

Nitric Acid: — May be employed if a stronger agent 
is desired (HI.), but other remedies are preferable. 
The use of a Seton is an old and effective method. 
(Bt.) 



RECTUM AND ANUS, PROLAPSUS OF 

In recent prolapsus the immediate indication is re- 
placement of the bowel and relief of strangulation. 
Place the patient on the left side with the pubis well 
elevated, the shoulders and head depressed, or in the 
knee and elbow position, in either of which the re- 
placement of the bowel is assisted by gravity. The 
fingers of the operator and the protruded mass 
should then be well lubricated and steady and gentle 
pressure exerted on the bowel in the direction of its 
narrowed position. This procedure will generally 
succeed. When the spasm of the sphincter is so great 
that reduction is impossible without injury to the 
bowel, and gangrene is threatened, the patient should 
be etherized and the sphincter dilated at once when 
the prolapsed bowel can be restored. (W). 

In children non-operative or palliative treatment 
is generally successful ; the child should never be al- 
lowed to sit and strain when the bowels move, but 
movements should be passed lying upon side or 
standing, one buttock being drawn aside so as to 
tighten the relaxed sphincter. When the bowel has 
protruded it should be douched with cold water and 
an astringent applied. (All.) 



462 DIGEST OF EXTERNAL THERAPEUTICS. 

The following time honored astringent remedies 
are recommended : 

Alum: — One of the most useful agents may be em- 
ployed in the strength of 2 drachms to the pint of 
distilled water (Gt.), or in solution with decoction of 
oak bark, 1 scruple to the pint, and stronger if well 
borne. (All.) 

Tannic Acid: — In the form of a strong watery so- 
lution, Infus. Matico, Krameria, Hamamelis (All.), 
Zinc. Sulph., grs.ii-^i, Tr. Iron grs. xx— xxx— giv (K.). 
All may be applied to the protruded bowel with a 
sponge or bit of soft cotton, and in the case of chil- 
dren adhesive plaster should be applied so as to draw 
buttocks together ; in adults a T bandage should be 
employed. 

Ergot: — The concentrated fluid extract injected into 
the submucous tissue in doses of 5-7 grains, repeated 
every second day for two weeks, is a procedure which 
has been recommended on high authority, Agnew 
and Langenbeck, but is deprecated by Allingham as 
uncertain and liable to produce abscess. 

Nitric Acid: — Very effectual in children, recom- 
mended when milder measures have failed ; the pro- 
truded bowel should be well dried and the acid ap- 
plied, care being exercised to protect the anus and 
skin by a bland ointment. The part should be well 
oiled and returned to the rectum, which, by some 
authorities, is recommended to be packed with cot- 
ton (All.). Others regard adhesive plasters binding 
buttocks together as sufficient. The limbs also had 
better be bound. Anaesthesia is of course necessary. 

In the treatment of adults nitric acid is only tem- 
porary in its effects ; in elderly persons it must be 
used with caution on account of deep sloughs which 



RECTUM, ULCER OF. 463 

may be produced in debilitated constitutions. (All.) 

Linear Cauterization: — In adults this is undoutedly 
the best means ; the patient is etherized and placed in 
the Sims position ; from three to six vertical stripes 
should then be made on the mucous membrane with 
the Paquelin cautery at a dull red heat. The stripes 
should begin three inches up the rectum and end at 
the junction of the skin and mucous membrane. 

Mr. Allingham in severe cases burns through the 
sphincter in two places at opposite points after re- 
ducing the bowel, and inserts a pledget of oiled wool. 
He applies the cautery before reducing the bowel. 
Van Buren, who first recommended the procedure, re- 
placed the bowel and applied the cautery through a 
speculum. 

In extensive cases of long standing the cautery may 
be applied to the whole circumference of the anus so 
as to produce cicatrical contraction. (K.) 

Clamp and Cautery: — Constitute the most radical 
treatment of this condition, and may be resorted to 
when all other means have failed ; for the technique 
of the operation see works on surgery. 



RECTUM, ULCER OF. 

Rest: — Is indicated in all stages of treatment. Rest 
in bed with fluid diet will alone cure some cases. (K.) 

Local treatment varies, and will require changing 
from time to time; it is long and tedious and will 
sorely try the patient, who will require much pa- 
tience. The first requirement of treatment is a thor- 
ough cleansing of the rectum ; this may be done by 



464 DIGEST OF EXTERNAL THERAPEUTICS. 

copious injections of sterilized water or Castile soap 
and water. (Gt.) 

Irrigation with some antiseptic solution is also 
employed with advantage before the application of 
local remedial agents. Solutions of Boric Acid, Cor- 
rosive Sublimate, 1-10,000-5000; Carbolic Acid, 
1—100, may be used for this purpose. 

Ointments: — These are generally to be preferred, as 
superior to suppositories. The rectal ointment ap- 
plicator is necessary for their administration. 

The following are recommended : 



Bismuth. Subnit., 


3". 


Hydrarg. Chlorid. Mitis, 


3"- 


Morph. Acetat., 


grs. ij. 


Glycerini, 


5". 


Vaselini, 


Si- 


This is very sedative and soothing. 




Iodofornii, 


grs. xx. 


Cocainse, 


grs. xviii. 


I^anolini, 


^ss. 


Allays irritation and pain. 


(All.) 



Hydrastis: — Useful in the proportion of about 1 
drachm of the fluid extract to one ounce of vaseline ; 
Iodoform may be added with advantage; Bella- 
donna, Opium and Stramonium in the form of oint- 
ments, combined with other remedies, form useful 
adjuvants for the relief of pain and spasm of the 
muscle. (Pt.) 

Balsam Peru: — A mixture composed of half an 
ounce of the balsam, glycerine 1 ounce, water 4 
ounces, will prove healing and soothing. The pure 
balsam will act well as a stimulant applied over the 
surface of the ulcer. (Gt.) Strong preparations of 
balsam of Peru will sometimes cause great irritation 



RECTUM, ULCER OF. 465 

applied to rectal ulcers, followed, however, by bene- 
ficial results. 

Nitrate of Silver: — A solution of grs. v-x brushed 
over surface of ulcer through the speculum is often 
beneficial. (W. C.) Copious irrigation with a solu- 
tion of grs. xx— xl— Oj is effective in dysenteric ulcera- 
tion. (All.) 

When the ulceration is high, the amount of fluid in- 
jected should be large ; three pints may be thrown 
into the upper part of the rectum, sigmoid flexure 
and lower part of the colon. The long flexible rubber 
tube should be employed, and the injection made 
slowly with the patient on the side. (K.) 

Cocaine: — In the form of suppositories or a solu- 
tion, grs. x— xv— gi, is often of great service in allay- 
ing pain and irritation. (Gt.) 

Glycerine: — Injection of 4 drachms as a lubricant 
and evacuant. (F.) 

Nitric Acid: — The fuming acid has been highly rec- 
ommended as a cauterant. (Gt.) 

Dusting powders introduced by an insufflator 
through the speculum are also very useful ; the best 
are the following: Acetanilid, Alum, Bismuth Sub- 
nitrate and Subiodide, Boracic Acid, Calendulated, 
Boric Acid, Iodoform, Lead Acetate, and Zinc Stear- 
ate. These remedies may also be applied in the form 
of ointments with the applicator after irrigation. 

They may be administered in the form of supposi- 
tories, though constituting the least desirable meth- 
od of applying remedies to the rectum as their in- 
troduction is often attended with pain. They are 
often used for the sake of convenience. 

Operative procedures are frequently necessary, viz : 

3i 



466 DIGEST OF EXTERNAL THERAPEUTICS. 

Forcible Dilation of the Sphincter, may be 
followed by two or three applications of nitrate 
of silver if the cause is traumatic; Curettage, of 
benefit, especially in tubercular ulcerations ; Linear 
Incision through the base of the ulcer ; Excision; 
Division of the base of the ulcer, including the sphinc- 
ter; Epileptical Incisions, when the ulcer is not too 
large and does not extend through the mucous mem- 
brane, may be made and the edges brought together 
with catgut sutures. (Gt.) 



RHEUMATISM. 

ACUTE ARTICULAR RHEUMATISM. 

Local measures play a secondary part in the treat- 
ment of the disease. The joints, whether involved or 
not, should be washed with warm water and soap, 
and enveloped in absorbent cotton or flannel, held in 
position by flannel bandages. These should be 
changed every two or three days, and the surface 
carefully cleansed with warm water. The entire sur- 
face of the body should also be carefully bathed at 
frequent intervals so that the skin is kept in good 
condition. Blankets, changed at suitable intervals, 
should be used for bed clothing, and the swollen 
limbs supported by pillows covered with flannel. 

(Gn.) 

Salicylates: — When not tolerated by the stomach, 
administration by the rcetum is often attended with 
satisfactory results. First wash out the bowel with 
warm water, then, after an interval, inject from 20— 



RHEUMATISM. 467 

40 grains of sodium salicylate in solution. This may 
be done every six hours. (Ty.) An ointment for ap- 
plication to the swollen joints is as follows : 

Acid. Salicylic, 

Lanolini, 

Ol. Terebinth., 

Adipis, aa 3 iii. (An.) 

The following have also been used for application 
to the joints: 

Liq. Opii Sed., %i. 

Potass. Bicarb., ^iv. 

Glycerini, gii, 

Aq. Bullient., 5* x - 

Soak a piece of flannel in the above hot solution and wrap 
around painful joint. (Os. ) 

Fuller's Lotion: 

Sod. Carbonate, 3 y i- 

Laudanum, §i. 

Glycerine, gii. 

Water, gix. 

Hot cloths saturated with this lotion may be applied to the swol- 
len points. (Os.) 

Paquelin Cautery: — Applied with a light touch 
above and below the joint is better than blisters, and 
acts well for the relief of pain. 

Fixation of Parts: — Is of great service; use splints 
for this purpose. (Os.) 

Cold Baths: — For hyperpyrexia the treatment must 
be energetic and prompt, extraordinary high tem- 
perature being inevitably fatal in a few hours. For 
this condition the one treatment is the application of 
cold. As soon as a temperature exceeds 105° the 
bath should be employed. If delirium or unconscious- 
ness is associated with the high fever the baths are 



468 DIGEST OF EXTERNAL THERAPEUTICS. 

all the more indicated. If time permits the tempera- 
ture of the baths may be gradually made cold, com- 
mencing with a temperature of 70°, and ice added if 
necessary. 

Ice Water Effusion: — Rubbing the head and body 
with ice may be substituted for the bath, though the 
latter is preferable. Numerous cases are reported 
with temperatures ranging from 107°-109° when this 
treatment was successful. (Ty.) 

CHRONIC ARTICULAR RHEUMATISM: 

Amber Oil as a rubefacient, viz.: 

Oil of Amber, £vi. 

Oil of Rosemary, 

Oil of Bergam., aa £i. 

Oil Turpentine, % i. 

Linseed Oil, ad. giv. (F.) 

Wintergreen Oil: — Equal parts, mixed with olive 
oil, applied to joints which are wrapped in cotton 
batting, is used for relieving pain. (F.) 

Massage: — One of the most important measures 
for the relief of stiffness, pain, and contractures re- 
sulting from rheumatism as well as the disease in the 
chronic state. It should be persevered in diligently 
and patiently. To remove nodosities the following 
plan has been recommended : Apply emollient poul- 
tices for one or two days continuously, then ener- 
getic kneading under anaesthesia to crush them ; fol- 
low this with daily massage. (Sj.) 

Sulphur Fumigation: — Subjecting the joint to the 
fumes of sulphur has proved useful. (F.) Somewhat 
on the same principle is the old-fashioned remedy of 
putting flower of sulphur in the stockings, which is 
n ot with out effect . ( Rd . ) 



RHEUMATISM. 469 

Iodine:— May be painted over joint with advan- 
tage. (Al.) 

Potass. Iodid.: — 90 grains, dissolved in water and 
rubbed up with an ounce of lanoline is often very 
beneficial; it should be well rubbed in over the 
affected part. (M. H.) 

Fir Wool: — For enveloping the joint, used especially 
by the Germans, but does not appear to possess any 
advantage over ordinary cotton, wool or flannel. 

(p.) 

Zinc-Sulpho Ichthyolate: — Sometimes proves use- 
ful in the form of a soap liniment, or ointment, in the 
proportion of 45 grains to the ounce. (F.) 

Ichthyol:— A 25-50 per cent, ointment or glycerite 
continuously applied to joint is likewise effective. 
(M. H.) 

Thiol: — Has been used in the following combina- 
tion : Thiol and vaseline, each 1 drachm ; lanoline, 1 
ounce. (Al.) 

Guaiacol:— Equal parts, with glycerine painted over 
painful joints and covered with a dry impermeable 
dressing will sometimes afford relief. (F.) 

Tr. Opii:— The following is endorsed by Hughes, of 
London : 

Tr. Opii, gi. 

Potass. Carbonat., gi. 

Aq. Bullientis, Oj. 

Apply with a soft cloth and cover with dry cotton. (Ga.) 

Conium:— An ointment of the bruised leaves, or the 
following, for the relief of chronic rheumatism or 
gouty synovitis : 



Ext. Conii, 


3i- 


Cocaintt; Hydrochlor., 


grs. v. 


Atropia Sulph. , 


gr. 1. 


Veratrinae, 


grs. xx 


Ung. Aq. Rosae, 


Si- 



(Sin. 



470 DIGEST OF EXTERNAL THERAPEUTICS. 

Superheated Steam: — A hot air cylinder con- 
structed for the purpose is used. The hand or arm 
is enclosed in asbestos and inserted into the cylinder. 
A thermometer is also inserted through a small hole 
in the tube ; care must be exercised that it does not 
come in contact with the limb. The initial tempera- 
ture does not usually exceed 70° C, and is increased 
according to the endurance of the patient; most pa- 
tients being able to endure a temperature of 120° C. 
without much discomfort. Profuse perspiration al- 
ways occurs and the air in the cylinder is soon sat- 
urated with moisture. It is believed that this must 
be the condition in all forms of apparatus, on ac- 
count of the ordinary laws of osmosis. Of course the 
skin does not attain anything like the temperature 
of the air in the clinder, and it is probably protected 
by the layer of gas formed from the evaporated per- 
spiration. The healing factors seem to be the per- 
spiration and the increased activity of the circula- 
tion. This diaphoretic action is not limited to the 
parts treated, but it may affect the whole body. The 
usual immediate results are relief of the pain, then 
increased activity of movement and loss of the feel- 
ing of weakness. (M. M. W., 5, 17, 98.) 

Liniments: — Chloroform, Aconite, Belladonna, 
Turpentine ; also the following combinations : 

Ol. Gaultheriae, 

01. Olivae, 

Lin Sapo., 

Tr. Aconit., 

Tr. Opii, aa 5"- 

Ol. Cajuput, 

Tr. Opii, aa 3ii- 
Ol. Terebinthinae, ^iv. 

Lin. Ammonise, §i. 



RHEUMATISM. 




Lin. Aconiti. (B. P.), 
Lin. Belladonnae, 
Glycerinae, 


aa £ii. 
ad. ^ii. 


Chloroform, 

Tr. Aconiti rad., 

Ol. Terebinthinae, 

01. Sassafras, 

Lin. Sapo. Camphorat., 


aa ^ss. 
M. v 
^iiss 



471 



Electricity: — In the form of faradism, is often of 
positive benefit. (Bt.) 

Pine Needle Baths: — A preparation sold in the 
markets ready for use, or the oil in the proportion 
of 1 minim to a gallon of water, form an agreeable 
and useful bath. (F.) 

Turpentine Baths: — 5—10 ounces to a bath tub full 
of water. 

Alkaline Baths: — May be used when the natural 
water of a mineral spring are not available. 

Hot Air Baths: — This method is often productive 
of good results, but is contra-indicated when there 
are organic cardiopathies. (F.) The limb is en- 
cased in a specially prepared cylinder containing air 
at a temperature of 150° F. and gradually increased 
to 240°. (F.) The application is continued for forty 
to forty-five minutes. (Sj.) 

Arsenical Baths: — Prepared by dissolving from 
15-45 grains of sodium arsenite and 3 ounces of 
sodium carbonate in a bath tub full of water. They 
are useful in rheumatic -arthritis, and may be admin- 
istered daily or every other day. Thirty baths, it is 
said, will relieve articular pain and stiffness. Gastric 
disorders may appear at the beginning, and the pain 
at first may be aggravated, but on discontinuing the 
sodium carbonate these symptoms disappear. 



472 DIGEST OF EXTERNAL THERAPEUTICS. 

Turkish Baths, Warm Sea Water, Sulphur 
Mud Baths:— Those of Schwalbach, Nauheim, Ma- 
rienbad, St. Arm and, Franzenbad are all useful; when 
there is cardiac disease the temperature must not be 
too high or the bath too long. 

Mineral Spring Baths: — A great number are rec- 
ommended for the treatment of the rheumatic dia- 
thesis and for chronic forms of the disease. A few 
of the better known are Richfield, Virginia, Hot Sul- 
phur, Mt. Clemens, and Glenwood. Great benefit is 
often derived from a course of treatment at one of 
these resorts. . 

MUSCULAR RHEUMATISM: 

Heat: — This is very effective in many forms, viz: 
Hot Water Bag or Bottle, Ironing the part with hot 
flat iron, while protecting the skin with a piece of 
flannel; Hot Douche, Hot Fomentations of Flaxseed 
Meal and Laudanum, Flannels wrung out in hot wa- 
ter and covered with oiled silk to retain heat, and 
Mustard Fomentations. 

Cold: — Sometimes useful, though heat is generally 
more agreeable. Methyl-Chloride Spray is said to 
cure in lumbago and pleurodynia, according to Bare- 
holm, almost immediately. (B.) Ether is also em- 
ployed for the same purpose, the relief being some- 
times permanent. (R.) 

Salicylic Acid: — A 2 per cent, ointment freely 
rubbed in the skin has given good results in subacute 
and obstinate cases. (An.) 

Ether or Chloroform: — A few drops subcutaneously 
in old cases is very beneficial. (B.) 

Massage: — One of the most effective agents; the 
application of a stimulating liniment may be com- 
bined with advantage. 



RHEUMATISM. 473 

Liniments: — The various anodyne and stimulating 
liniments are all used, the ones most useful being tur- 
pentine, chloroform and belladonna. (L. T.) 

The f ollowing is highly praised for muscular rheu- 
matism, lumbago and sciatica: 

Sod. Salicylate, ^ss. 

Ol. Cajuput, £ss. 

Ol. Eucalypt., M. xv. 

Ivin. Sapo., ^ss. 

Spts., Rect., %vi. (T. 97.) 

Also, 

Lin. Chloroformi, J>iii- 

Tr. Iodi, 

Tr. Aconit., Rad., aa gii. 

Tr. Opii, ^ss. (Sn.) 

Iodine: — The tincture painted on is sometimes of 
service, and the ordinary ointment when there is 
more tenderness of the muscles than of the skin. (R.) 

Capsicum: — Steep a handful of crushed pods in half 
a pint of hot water for twenty -four to thirty-six 
hours, then strain and bottle for use. Soak a piece 
of lint in this liquid and apply to the affected part, 
which should be covered with oiled silk. It does not 
vesicate, and will relieve in a most striking way. (R.) 

Anodyne Colloid.: — Often affords quick relief; if 
pain continues a piece of absorbent cotton, wet with 
warm water, should be placed over the film. (F.) 
(See Neuralgia.) 

Morphine: — Hypodermically over the seat of pain 
will often cut short an attack if seen early. (An.) 

Belladonna: — The plaster or ointment (the latter 
preferable). (Al.) 

The following also is used : 

Ung. Belladonnse, 

Ung. Iodi, Comp., aa ^ss. 

Rub in twice a day and apply heat. ( Sn. ) 



474 DIGEST OF EXTERNAL THERAPEUTICS. 

Theine: — Hypodermically, in doses of gr. I has been 
used with success. (F.) 

Osmic Acid: — Hypodermically in doses of 8-10 
drops of al percent, solution, deep in the muscle. (F.) 

Strapping: — This will be found of service in pleuro- 
dynia ; the involved muscles may be treated by com- 
plete rest by strapping the side as in fracture of the 
rib. (Ty.) 

Aquapuncture: — Has been successfully employed. 

Braunscheidtismus ; — An old remedy, will some- 
times afford instant relief. (B.) 

Paquelin Cautery: — Applied gently and rapidly 
over large surfaces, is said to " act like magic." (L.T.) 

The practical use for such a heroic remedy would 
seem doubtful. 

Hydrotherapy: — Warm or cold pack, Turkish 
baths, hot air baths, sulphur and other mineral 
springs (as advised in chronic rheumatism). 

Electricity: — Either in the form of galvanism or 
faradism, is useful in chronic cases. 



RHINITIS. 

ACUTE RHINITIS— CORYZA. 

Menthol. — One of the most frequently employed 
remedies for this condition. It is given first import- 
ance by Lennox Browne, being preferred by him to 
cocaine. He advises its administration by any one 
of the following methods : 

1. A 10 per cent, solution in almond oil, in 
liquid vaseline, or in one of the many odorless par- 
affine compounds, to be sprayed into the nose or 
about the room. 



RHINITIS. 475 

2. By placing 1—2 drachms of the oily solution in 
a Lee's steam draft inhaler or a bronchitis kettle. 

3. To carry a Cushman's pocket menthol inhaler. 
(The most convenient method). 

The vapor of the following combination, inhaled 
from a wide-mouthed bottle or pocket inhaler, will 
add to the comfort of the patient : Oil of menthol, 1 
drachm, with carbonate of ammonia, half an ounce ; 
also, oil of menthol, 1 drachm, with 2 drachms each 
of camphor and carbonate of ammonia. 

Menthol Chloroform: — In the strength of 10 per 
cent., for the purpose of aborting. Place a few drops 
on a handkerchief, and take about five deep inhala- 
tions. The secretions are at first increased, but after- 
wards diminished. (T. 97.) 

Carbolic Acid: — A popular German remedy, called 
Hager's, is as follows : 

Acid. Carbolici, £i. 

Alcohol, Fort., ^ iij. 

Aq. Ammonise, Fort., ^i. 

Aq. Destill., gij. 

To be used as an inhalation from an open-mouthed bottle. 

Half an ounce of a 1—20 solution to a pint of water 
is useful in washing out the nose. (T. 96.) 

Steam Inhalations: — Always grateful; following 
may be added to boiling water in about the propor- 
tion of a teaspoonful of the mixture to half a pint : 



Or, 



Tr. I/upulin, 


3*1- 




Tr. Benzoni Comp., 


f 3vjj. 




Camphorae, 


3SS. 




Ol. Eucalypti, 


M. x. 




Tere'oin., 


M. xij. 




Alcohol, 


ad. fij. 


(Bn 



476 DIGEST OF EXTERNAL THERAPEUTICS 

Camphor: — An old and well-tried remedy; the 
spirits may be inhaled from a bottle, or when added 
to boiling water in some of the combinations as 
mentioned. 

Chloroform: — One drachm may be added to the 
benzoin inhalation above mentioned, to increase its 
sedative action. (Al.) 

The foil owing are to be employed with the atomizer: 

Calendula: — Very useful after operations about the 
nose, viz : 

Succus Calendulae, 3Jss. 

Ung. Ol. Iviq. Albolene, ^ij. (Tn.) 

Cocaine: — Is used for controlling the venous tur- 
gescence. It is claimed that it has more than a palli- 
ative action. Applied every three or four hours it 
may arrest or control the attack ; the following for- 
mulas are recommended : 

Cocain. Hydrochlorat. , grs. xx. 

Morphinae, grs. ij. 

Aquae, ^i. 

Ft. Sol. et adde 

Cosmolin. Liquid., |ji. 
Apply with a Burgess atomizer. ( Bos. ) 

Cocain. Hydrochlorat., grs. v. 

Ol. Eucalypti, M. xx ad. fl sp. 

Vaselini vel. Lanolini, ad. J;i. 

Mackenzie recommended the following effective 
combination : 

Menthol, grs. v. 

Pinol, M. v. 

Benzoinal, ^i. 

Snuff Powders: — Are very often used, but are not 
as effective as sprays. Moreover, to some very sensi- 
tive mucous membranes the effect of a powder is not 
as agreeable as a spray. 



RHINITIS. 477 

The following are recommended : 

Morphinae Hydrochlorat. , grs. ij. 

Pulv. Acaciae, gii. 

Bismuth. Subnit., gvi. 

This is known as " Ferrier's Snuff." In using prep- 
arations of morphine it must be remembered that 
the drug can readily be absorbed by the nasal mucous 
membrane : 

Antipyrin, 

Camphor, 

Sac Lac, ad. giii. (Bn.) 

Cocain. Hydrochlor., 
Menthol., 
Acid. Salicylic, 
A.cid. Boric, 
Amyli, 
A pinch every two hours after blowing the nose. 

Cocain. hydrochlorat., 

Bismuth. Salicylat., 

Pulv. Camphorae, ^i. (T. 96.) 

Eucalyptus: — Infusion of the leaves for washing 
out nostrils, or the oil a few drops on cotton inserted 
into the nostrils for the relief of the sensations of 
fullness. 

Chamomile: — Infusions with a little alum intro- 
duced into the nostrils, is very useful for the coryza of 
infants. (T. 7.) 

Boric Acid: — An ointment made with vaseline in 
the strength of 10 per cent, for application to the 
nose when there is irritation. (T. 96.) 

Lemon Juice: — The hands are rubbed with some 
drops of the liquid, and are then held in front of the 
mouth or nose, while deep inspirations are taken. 
The sneezing is said to cease after the first few inhal- 
ations. (T. 96.) 



grs. 


Xll. 


grs. 


X. 


giii 




grs. 


iss. 


grs. 


iiss. 


grs. 


viii 


3i- 




3iss. 


grs. 


3 

4' 


gss. 




3i- 


( 



478 DIGEST OF EXTERNAL THERAPEUTICS. 

Hot Foot Bath:— At bed time, in conjunction with 
copious draughts of cold water during and after bath 
to induce free perspiration, when promptly carried 
out will often avert a cold in its incipient stages. 
(Rd.) 

To Diminish Excessive Sensitiveness to Cold: — 1. 
Free exposure to the open air, daily. 2. The morn- 
ing cold bath. Cold sponging over the entire sur- 
face of the body, the plunge bath, or the shower bath, 
are invaluable methods of protecting the body 
against injury from exposure to changes of tempera- 
ture. Taken regularly in the morning, the cold bath 
inures the surface of the body to a greater degree 
of cold than it will probably encounter during the 
day; at the same time it promotes a vigorous capil- 
lary circulation, which is essential to the harmonious 
and healthy working of the system. 3. Breathing 
through the nostrils. Infants should be taught to 
breathe through the nostrils, especially during sleep. 
(Rd.) 

SIMPLE CHRONIC RHINITIS: 

Cleanliness: — Is the first essential ; the nasal cavities 
should be thoroughly and carefully cleansed of all 
mucus accumulations before local remedial agents 
are applied. The following are effective for this pur- 
pose, using the condensed air apparatus, but the 
nasal atomizer may be employed by the patient at 
home: Seiler's antiseptic tablets, Dobell's solution 
and benzoic acid, grs. x, with 2 drachms each of 
chloride of sodium and bicarbonate of soda ; half of 
this powder being added to a glass of water. Or, 
Borax, 2 grains to the ounce of water, together with 
a little glycerine, may be used. (Bp.) 



RHINITIS. 479 

After the nasal cavities have been cleansed altera- 
tive or astringent applications should be employed, 
according to the indications; these, generally speak- 
ing, are of two varieties, liquids, including oleagi- 
nous preparations, and solutions, and insufflating 
powders; the former should be applied in the form of 
a spray by means of the compressed air apparatus. 

Liquid Applications: — The petroleum oils form the 
menstrum for the oleaginous compounds, viz: 
Albolene, Benzoinal, Cosmoline, Lanolin, liquid 
Vaseline, etc. In these some medicinal agent is dis- 
solved, usually in proportion of 1—10 per cent. 

Camphor. -Menthol: — 10 per cent, in lanolin is a ser- 
viceable remedy ; it relieves stenosis, and congestion, 
and prepares the body for the two succeeding formulas: 

Calendula: — 4 parts, hamamelis 8 parts, pinus 
strotus 8 parts, lanolin 80 parts. (Bp.)" 

Hydrastis: — 1 drachm of tincture to the ounce 
of water is useful when there is a tenacious, stringy 
mucus dropping from the posterior nares. 

Menthol Crystals: — grs. v-x, Albolene, gi. (Ty.) 

Terebene: — Gtts. x, Albolene gi, applied twice 
daily, is one of the most effective applications. (Bp.) 

Cocaine: — A 4 per cent, solution will relieve when 
there is considerable temporary swelling of the mu- 
cous membrane. (Iv.) 

The following solutions are also serviceable for ap- 
plication with the atomizer : 

Ext. Pini Canaden., gtts. xx. 

Glyceritri, *&&. 

Aquae, gi. (Qy.) 

Or, 



Thymol, 


grs. x. 


Eucalyptol, 


grs. xx. 


Menthol, 


grs. xxx. 


Oil of Cubebs, 


grs. xl. 


Oil of Rose, a sufficiency. 




Benzoinol, 


giv. 



480 DIGEST OF EXTERNAL THERAPEUTICS. 

Or, 

Thymol, grs. ss. 

Alcohol, gss. 

Glycerini, ;jiss. (F. ) 

Water, 5 i. 



Or, 



Acid. Carbolici, grs. ii-v. 

Aquae, ^i. (Al.) 



Insuffla ting Po wders : 

Aristol: — Alone, or in combination with Boric or 
Tannic Acid, forms a very astringent powder. 

Cerium Oxalate: — 20 grains to the ounce of acacia, 
for catarrh in children. 

Cubebs: — In fine powder. 

Europhen: — For catarrh of children, and for re- 
ducing hypersecretion following surgical operations. 

Salicylic Acid: — Mixed with some indifferent me- 
dium in equal proportions. 

Potass. Sozoiodol: — Equal parts with talc, or in 
proportion of 1—2, is highly commended. 

Sodium Sozoiodol: — In the proportion of 1—2 with 
talc, especially when discharge is muco-purulent. (Al.) 

Gallic Acid: — 4 grs, with acacia, 2 grs., after cleans- 
ing with solution of bicarbonate of soda, one of the 
best applications. (Iv.) 

Tannic Acid: — 2 parts, iodoform, 1 part, carefully 
triturated. (F.) 

Zinc Oxide Iodid.: — 15 grains to the ounce of some 
indifferent powder. (F.) 

Cauterization: — When engorgement of the turbi- 
nate bodies produces swelling of these structures and 
consequent constriction of the nasal passages, the 
cautery is indicated. The galvano-cautery should be 



RHINITIS. 481 

used touching the sensitive areas as practiced in hay 
fever. (Ing.) 

In absence of the galvano-cautery, normal cauter- 
ants may be use, as mentioned for the treatment of 
hypertrophic rhinitis. (Bp.) 

Sea Bathing and Sea Water: — Often very beneficial. 
(Iv.) 

Ethyl Chloride:— 5-20 drops on a handkerchief, in- 
haled, has a good effect. (B.) 

Bougies: — Act in two ways, namely, by retaining 
the medicinal agent in contact longer, and by exert- 
ing pressure; a small piece of cotton should be placed 
in the nostril to prevent flow of mucus. (Al.) 

ATROPHIC RHINITIS: 

Thorough cleansing is the first requirement. This 
is best accomplished by detergent alkaline sprays, 
as Dobell's Solution, Seller's Antiseptic Tablets, 
solutions of Boric Acid, or Borax. Crusts not re- 
moved by these agents may be brought away by 
means of a probe wrapped in cotton and dipped in 
vaseline. 

Hydrogen Peroxide: — When the crusts of inspis- 
sated mucus are difficult to dislodge, they may be 
softened by pledgets of lint soaked in the peroxide 
and inserted into the nostrils. (Bl.) 

Galvano-Cautery Electrode: — Is used for the re- 
moval of the crusts. The electrode is introduced 
cold, put in contact with the crusts, which, when the 
current is turned on, adhere with great tenacity to 
the heated electrode and are then removed with ease. 
(Bn.) 

After cleansing, the mucous membrane is ready for 
the application of some alterative or astringent 
32 



482 DIGEST OF EXTERNAL THERAPEUTICS. 

agent, which will vary in strength according to the 
sensitiveness of the parts. 

The following cleansing deodorant, antiseptic and 
alterative remedies are for aplication by the atomizer 
or condensed air spray apparatus. 

Thymol: — Is a useful deodorizer and cleanser, but 
does not have any great influence on the course of 
the disease. The f ollowing is grateful : Thymol, 10 
grains ; eucalypol, 20 grains ; menthol, 30 grains ; 
oil of cubebs, 40 grains ; oil of rose, a sufficiency ; 
benzoinal, 4 ounces. The solution may be used 
stronger or weaker as the condition requires. A so- 
lution stronger than 5 per cent, is seldom, if ever, re- 
quired. (F.) 

Ichthyol: — Gtt. xx— xxx ; albolene, §i. 

Mercuric Bichloride: — Grs. ss ; albolene, §i. 

Potass. Permang.: — Grs. v; aque, gi; especially 
when discharge is persistent is a good deodorizor, 
but not as lasting as some others. (F.) 

Camphor Menthol: — 10 percent, solution in lano- 
line when odor is very foul. (Bp.) 

Thiol : — In the following combination, by means 
of oil atomizer, three or four times a day : Powdered 
thiol, grs. x ; menthol, grs. v ; liquid blancolin, gi. 
(T. 98.) 

Pheno-Salyl.:— Sol. 1-1000, with a little salt. 
(T. 98.) 

Creoline :— Sol. 1-1000. ( Al. ) 

Hydrastis: — Fid. ext., gi; aq. destill., Oj. (B.) 

Labarraque's Solution: — In strength of 15—20 
drops to the ounce is most useful for correcting odor. 
(Al.) 

Zinc Sulphate: — Weak solutions have been used to 
cleanse. (F.) 



RHINITIS. 483 

Iodine: — In solutions of varying strengths is of 
great service. One of 4 per cent, in lanolin, and also 
the following may be mentioned : Iodine, grains 5 ; 
iodide of potash, grains 10; glycerine, lounce; dilute 
with water as condition demands. 

Alcohol: — Diluted according to the susceptibility of 
the patient, forms one of the simplest and best appli- 
cations. (Bn.) 

Nasal Douche: — In addition to the spray, the pa- 
tient should use once a day, by means of the nasal 
douche, one or two quarts of hot water with salt, a 
half ounce to the quart ; the water should be used as 
hot as can be borne. (Bos.) 

The following powders may be given by insuffla- 
tion: 

Aristol: — With Zinc Stearate Compound. 

Europhen: — Especially in scrofulus children; Noso- 
phen; Iodo-Tannin; Calomel, grs. v; Sac. Alb., ^ss; 
Zinc Zozoiodate, 1 part ; with Talc, 10 parts, when 
an excitant action is desired. 

Nitrate of Silver: — Of great benefit. Solutions vary 
according to the sensitiveness of the mucous mem- 
brane; 10—40 grains to the ounce are recommended, 
applied with cotton applicator every second or third 
day with lengthening intervals. (Ty.) At home the 
patient should use in the morning the following 
spray : 

Hydrarg. Bichlorid., gr. i. 

Aq. Laurocerasi, ^iii. 

Aq. Destill., Osj. 

in the evening; the same followed by this ointment: 

Hydrarg. Oxidi Flav., grs. vi-x. 

01. Bergamont. , grs. vi. 

Vaselini, ^ i. 



484 DIGEST OF EXTERNAL THERAPEUTICS. 

Susceptibility of some patients to mercury, espe- 
cially in the nose, renders caution necessary. The ap- 
plications, therefore, may be weaker. (Bn.) 

Iodoform: — In the form of bougies or wafers con- 
taining 2-5 grains, or 1 grain by insufflation. (Al.) 

Trichloracetic Acid: — 10—15 per cent, aqueous so- 
lution applied two or three times a week by means of 
cotton covered silver probe, and rubbed on points. 
(Sin.) 

Balsam Pine — Cotton tampon, soaked with the 
remed}^ and carried into nasal chambers. (Al.) 

The following ointments are commended: 

Europhen: — 10 per cent, ointment on cotton tam- 
pons, left in situ half an hour. 

Hydrarg. Oxidi Flav.: — 10 grs. to fresh lard, 1 
ounce, applied on septum when there is bleeding or 
ulceration. (Ty.) 

Calendula or Hamamelis Cerates: — To the septum 
for bleeding ulcerations. (Ty.) 

Creosoti: — With oil of anise, each 10 drops; vase- 
line, 1 ounce ; a small portion in nostril forms a useful 
application . (Sm . ) 

Galvanism: — Dr. Delevan recommends the follow- 
ing: The positive electrode is placed on the nape of 
the neck, and the negative, wrapped in absorbent 
cotton, is applied directly to the nasal mucous mem- 
brane ; the strength of the current is four to seven 
milliamperes, and the duration seven to fifteen min- 
utes or until a watery secretion is induced ; excellent 
results are claimed. (Bos.) 

Galvano- Cautery : — Recommended by Lennox 
Browne, Sajous and others. The electrode is applied 
at various sittings to successive portions of the mu- 



RHINITIS. 485 

cous membrane so as to produce as many small 
eschars as possible; insufflation of iodoform or iodol 
may follow the applications. The use of the galvano- 
cautery is regarded by other writers as a measure to 
be employed only with great caution, as it is capable 
of doing much harm. As a stimulating agent it is re- 
garded by Bosworth as productive of good results in 
the earlier stage if applied with great care. 

Vibratory Massage: — Applied as follows: A piece of 
absorbent cotton, loosely torn from roll, is inserted 
into the inferior meatus, completely filling it, and the 
space between the middle of the inferior turbinate 
bone and the septum. The dry cotton is held on the 
holder, and vibratory movements are carried over 
the mucous membrane of the inferior, middle and su- 
perior tubinated bodies, pharynx, septum and floor 
of nose. From 3-6 pledgets of cotton are necessary 
in each nostril in order to cleanse. The mucous mem- 
brane after the massage looks pink and clean, and 
there is a feeling of relief. Immediately afterward 
some such application as 10 per cent, iodoglycerine 
may be made. Applications are to be made dailv. 
(Bp.) 

Electrolysis: — Claims have been asserted for a 
large percentage of cures with bi-polar electrolysis. 
20 milliamperes for 20 minutes at each sitting, cop- 
per needles being used and inserted into the submu- 
cous tissues. (T. 98.) 

Sea Bathing: — Often of great benefit, both from its 
local and constitutional effect; residence by sea is 
also beneficial. (Bos.) 



486 DIGEST OF EXTERNAL THERAPEUTICS. 



HYPERTROPHIC RHINITIS: 

In the earlier stages spray applications will be 
found of great benefit, and will often arrest the pro- 
gress of the disease ; they must be applied with care 
and thoroughness under the fullest illumination and 
inspection. A large number of formulae have been 
suggested, of which the following may be mentioned: 

Fid. Ext. Hamamelidis, Destill., 

Aq. Rosae, aa ^ii. (Bn.) 

Acid. Carbolic, grs. iii, 

Sod. Bicarb., grs. xii. 

Sod. Biborat., grs. xxx. 

Glycerini, gss. 

Aquae, ad. ^\\. (Bos.) 

Acid. Borici: — Grs. x— ^i. 

Zinc. Sulpho. Carbolat.: — Grs. ii— ^i. 

Resorcin:— Grs. v— ^i. 

Petroleum preparations, such as Albolene, Ben- 
zoinal, Glycolene, etc., may be substituted for 
aqueous solutions when there is great irritability. 
Various remedies may be combined with these oils 
with good effect, the most useful being Oil of Euca- 
lyptus, Oil of Sassafras, Oil of Pine Needles, and 
especially Menthol, the strength being from 2—6 
grains to the ounce of the petroleum base. (Bn.) 

Iodine: — In cases of moderate fibrous thickening 
applications to the turbinated bones are valuable. 
Solutions of the crystals, 10 grains, with potassium 
iodide, 40 grains, to glycerine, 1 ounce or from 2-5 
drachms of the tincture, with enough glycerine to 
make 1 ounce. An applicator covered with cotton 
should be used. (Bn.) 



RHINITIS. 487 

When the above line of treatment, combined with 
proper hygiene and internal remedies, has proved 
ineffective and more energetic measures are required, 
the following should receive consideration : 

Chromic Acid: — Soft and vascular enlargements 
are best removed by this agent, not used as a general 
escharotic but according to the following manner : 

First apply cocaine, 5 per cent, solution, to contract 
and anaesthetize the parts to be operated upon. This 
may be done by inserting small pledgets of cotton, 
saturated with the cocaine, between the septum and 
turbinates, allowing them to remain 5—10 minutes ; 
the chromic acid is now to be applied, using it on the 
end of a small probe in the form of a fused bead or a 
few crystals on a tightly wound strip of moistened 
cotton. The application is made to the point of 
greatest hypertrophy, and should be kept applied 
about fifteen or twenty seconds. After this the mass 
should be sprayed with an alkaline solution, such as 
Dobell's. The cauterizations should be repeated at 
intervals of seven to twelve days until physiological 
respiration is attained. In the intervals sedative 
sprays should be applied. (Bn.) 

Another method of applying chromic acid is to in- 
cise the mucosa, separate it from the erectile tissue 
by means of a flat probe or spatula, and then insert 
a probe with the fused acid on its tip. (T. 98.) 

Trichloracetic Acid: — Has been strongly advised. 
An aluminum rod, with a hollow in its distal ex- 
tremity in which a few dry crystals are placed, is 
used. Applications are made in the same manner as 
with chromic acid. It is claimed there is little, or no, 
inflammation, reaction, and the eschar is dry and 
aseptic. (Bn.) 



488 DIGEST OF EXTERNAL THERAPEUTICS. 

Galvano-Cautery : — When decided fibro-elastic 
changes have taken place, more energetic treatment 
is required ; for these conditions the galvano-cautery 
is the best method ; with it there is no reaction, and 
no difficulty in limiting the amount of destruction. 
The application may be repeated every three or four 
days, or as soon as the eschar has disappeared. (Bos.) 

Snare or Electric Trephine (Whiting): — These 
methods are to be preferred for reduction of hyper- 
trophy of the turbinated bones. (Iv.) 

Septal hypertrophies are best treated with the 
Saw, Dull Chisel, or Knife. (Iv.) 

When fibro-ellastic changes have progressed so far 
that much of the turbinated tissue has become tendi- 
nous in structure the outlook for cure is unfavorable, 
though much can be accomplished in securing com- 
fort and arresting the progress of disease. The use 
of alterative sprays, such as those agents mentioned 
under chronic rhinitis, especially solutions of Thymol, 
Zinc Iodide, and Zinc Sulpho-Carbolate, are of 
great value. They must be applied at first daily and 
toward the end of four to fourteen months' treat- 
ment once a fortnight. The Snare or Curette should 
be used in this stage to remove myxomatous and 
papillomatous tissue. (Bn.) 

Faradism: — Is valuable in the advanced stages, 
using a straight nasal electrode, long enough to 
reach the pharyngeal wall when introduced through 
the nostril. The current should be carefully applied. 

General hygienic measures are of great importance. 

Exercise: — Riding, bicycling, regular and frequent 
bathing, daily sponging face, neck and chest with 
cold water. Forcible efforts to clear the nostrils are 
to be avoided, as they increase the general irritation. 



SCABIES. 489 

The matter of clothing should receive attention, 
care being observed that it is sufficiently warm for the 
season. " Catching cold" should be carefully guarded 
against. 



RING WORM. 

(See Trichophytosis.) 

SCABIES. 

Before attempting any of the various methods of 
treatment, the condition of the patient's skin must be 
considered. If highly irritated or covered with an in- 
flamed eruption, it must be treated with Bran Baths, 
Soothing Ointments, such as Zinc Oxide or Bismuth 
Subnitrate, in the proportion of 1 drachm to 1 ounce 
of Ung. Aq. Rosae. As soon as the skin is in condi- 
tion ; one of the following methods may be em- 
ployed (B. H.): 

Sulphur: — A time-honored and effective remedy is 
used in various forms and combinations. An oint- 
ment of 2 drachms to the ounce is recommended by 
Kippax, applied in the following manner : The pa- 
tient first takes a hot bath with plenty of soap ; then 
the ointment is rubbed in thoroughly over the whole 
body, and allowed to remain on over night, and in 
the morning another hot soap and water bath 
should be taken ; the same programme is followed 
every night until every trace of itching has disap- 
peared. In the majorit3 r of instances three days will 
effect a cure. (Kp.) 



490 DIGEST OF EXTERNAL THERAPEUTICS. 

Fourneir recommends for private practice a prelim- 
inary nibbing with good toilet soap ; then the appli- 
cation of Botirguignon's ointment, which is as fol- 
lows : 



Glycerine, 


200 parts. 


Gum Tragacanth, 


5 parts. 


Sublimated Sulphur, 


100 parts. 


Carbonate of Potassium, 


35 parts. 


Oil of Lavender, 




Oil of Peppermint, 




Oil of Cloves, 




Oil of Cinnamon, 


each 150 parts 



This is followed by baths and powders of corn 
starch. Its use is contra-indicated in adults when 
much excoriation is present, and should never be ap- 
plied in the case of children. 

The following method is that of Bazin and Hardy ; 
it is recommended as highly effective if the patient is 
an adult and the skin in not over-sensitive; it is di- 
vided into three stages : 

1. Patient scrubs and washes himself in lukewarm 
water with green soap all over, except face and head, 
for twenty minutes. 

2. Patient then soaks in a lukewarm bath for 
twenty minutes. 

3. Rub all over body for twenty minutes, except 
head and face, paying special attention to the part 
covered with the eruption, the following ointment 
known as Hardy's modification of Helmerich's 
pomade : 

Potass. Carbonat , ^i. 

Sulphuris Praecipit. , 3 ii. 

Adipis, ^ iss. 

The ointment is allowed to remain on the surface for twenty- 
four hours. It should be so prepared as not to contain any undis- 



SCABIES. 491 

solved particles of the potash. A bath is now given, and the skin, 
where excoriated, is dressed with Zinc Oxide (5), Benzoin Oint- 
ment (§), and a little starch dusted on. This, it is said, rarely 
fails to eradicate the disease. This application may be repeated 
once or twice if necessary. If any irritation of the skin remains, 
administer bran baths for a week or so. (B. H.) 

Wilkinson's ointment, modified as follows : 

Sulphur. Sub., 

01. Cadini, aa 5 SS - 

Cretse Prseparat., 5 nss - 

Sapo. Vir., 

Adipis, aa §i. 

This is only fit for hospital use, as it is most disagreable, though 
effective. (Ja.) 

/?-Naphthol: — Recommended in 10 per cent, oint- 
ments, or in the following combination : 

B-Naphtholi, grs. lxxx. 

Saponis Viridis, % ss. 

Cretae Alb., Pulv., gr. j. 

Adipis, J i. 

Apply every morning for five or six days and administer a bath 
every second day. (Kap. ) 

It is well adapted to cure the eczemas which often 
accompany this affection. Van Harlingen says that 
he has used for years one or the other of the follow- 
ing formula? exclusively for this affection, viz : 



Pulv. Naphtholi, 


3i- 


Ung. Adipis, 


Si- 


Or, 




Pulv. Naphtholi, 


3Jss 


Saponis Viridis, 


3v. 


Cretae Alb., Pulv., 


3i- 


Axungiae, 


3*. 


The latter is adapted for coarse skins. 





492 DIGEST OF EXTERNAL THERAPEUTICS. 

Balsam Peru:* — Is recommended for young children 
and infants and for feeble patients with secondary 
eruptions. For children : 

Balsam Peru, 3iH- 

Ichthyol., 3 SS - 

Lanolini, 3ij- 

Ung. Aq. Rosae, ^iv. 

Albolini, (Liq.) Sii. (T. 98.) 

Or, 

Balsam Peru, 

Sulphuris, aa 3i- 

Adipis, 5i. (B. H.) 

For adults : 

Balsam Peru, 3 V - 

B-Naphtholi, 3i. 

Adipis, 5vj. (T. 97.) 

The patient is rubbed at night for fifteen to twenty minutes, and 
sleeps in a nightshirt impregnated with the balsam. The next 
morning a warm bath, with plenty of soap, is given. It is claimed 
the vapor of the balsam kills the parasite. 

Styrax: — The use of this remedy within the last 
few years has been revived. The following formulae 
are recommended as efficient : 

Liquid Styrax, §i. 

Alcohol, 3"- 

Olive Oil, 3i. 
Use for two frictions. (N.) 

Or, 

Styrax, % i. 

Rectified Spts. of Wine, gii. 

Olive Oil, ad. %\. 

Rub the parts thoroughly, and repeat in twenty- four hours. 

(And.) 

* Note. — The use of Balsam of Peru is not wholly without danger, 
as this agent has been known to cause Nephritis. It should not, 
therefore, be used when there is any kidney lesion present or any 
tendency in that direction. When applied the urine should be ex- 
amined at frequent intervals. 



SCARLET FEVER. 493 

A warm bath should precede the application of the 
remedy. Of one hundred and twenty -four cases thus 
treated by Unna, albumin appeared in the urine in 
nine. The treatment, however, -was generally suc- 
cessful. (N.) 

The following combination with sulphur is recom- 
mended as being efficient in six rubbings : 

Sulph. Sublimat., 3*- 
Saponis Viridis, 3^- 
Styracis Liquid., 3J SS 
Cretse Prseparat., fi- 
ling. Aq, Rosse, q. s, ad. gi. (T. 98.) 

Oxynaphthoic Acid (9iv, with powdered chalk and 
green soap, each 9iv, and lard to ^i) or Creolin (^ss 
to lard ^i) are said to act very quickly without irri- 
tating the skin. 

All underclothing and bedding must be burned or 
disinfected. 



SCARLET FEVER. 

High temperature does not require very active 
treatment unless organic or functional disturbances 
of the heart or brain result ; as long as these two or- 
gans perform their functions naturally, the tempera- 
ture may be let alone. 

Baths: — For high temperature and non-appearance 
of eruption : 

If in thirty-six hours the eruption does not develop, 
place the patient in a water bath at 100° for ten 
minutes. If there is no appearance of eruption, re- 
peat in three or four hours. If the second bath has 
no effect, and especially if the temperature remains 
high (above 104.5°) and the patient is becoming 



494 DIGEST OF EXTERNAL THERAPEUTICS. 

drowsy, a cool bath at a temperature of 80° must be 
administered, cooling the water gradually down to 
65°. The low temperature is indicated if the fever 
does not fall. If the cool bath fails, or if in spite of 
reducing the temperature the cerebral symptoms re- 
main, dash the face and upper part of trunk with 
water at 50°— 60°. For this purpose the patient may 
be placed upon a rubber sheet, and if convenient, a 
small hose, with attachments to both the hot and 
cold water spigots, so that the temperature can be 
regulated, may be played upon the patient. The 
value of this treatment is not alone for the reduction 
of temperature, but for its stimulating effects upon 
the depressed nerve centres. It must be administered 
with judgment and care, and not employed unless the 
temperature is 105°, and so persists, with increasing 
severity of cerebral symptoms. (Gn.) 

In malignant scarlet fever with hyperpyrexia, cold 
baths must be used freely, for unless the temperature 
goes down the patient may die in a few hours. 

Cold Packs: — Are invaluable, especially at the on- 
set of the disease, when the eruption does not ap- 
pear and the temperature is high (Rd.); they are also 
indicated in septic forms and those marked by per- 
manent cerebral symptoms. (Hit.) The packs may 
be repeated several times at intervals of an hour as 
long as the fever remains high. 

They may take the place of cold baths which are 
not approved by some writers (Jacobi, Ashby, 
Wright). Holt regards cold packs as superior to 
medicinal antipyretics, and as almost as effective as 
the bath; they are also much easier to administer 
and less likely to excite opposition on the part of 
the friends. (Hit.) 



SCARLET FEVER. 495 

Mustard Baths: — Of great service when there is re- 
trocession of the eruption. Use 1 drachm to the 
gallon. (Al.) 

Sponging: — With cool or tepid water is useful in 
many cases when the temperature is high, and the 
pulse frequent and feeble. (Jac.) 

Hot Baths — Indicated when the surface and ex- 
tremities are cold, pulse frequent and filiform. Strong 
friction should be applied in conjunction with the 
baths. (Jac.) 

Warm Baths: — At a temperature of 95° were ad- 
ministered in 110 cases twice a day. Nephritis did 
not occur and desquamation was mild. (T. 98.) 

Hot Water Enemata: — May be employed in the 
same conditions calling for hot baths. (Jac.) 

Cold to the throat: — Is often very comforting and 
effective in allaying glandular inflammation. Little 
rubber bags of ice, or ice wrapped in dry cloths, may 
be used. (Ty.) 

Anointing the Body with Oils: — Constitutes a use- 
ful adjuvant in allaying irritation of the skin, and 
during the stage of desquamation in preventing 
the scales from flying about. Suet, sweet oil, 
vaseline, or cocoa butter may be used for this pur- 
pose, the latter being preferable. 

Oil of Eucalyptus: — Remarkable results are re- 
ported from the use of this remedy ; the body is care- 
fully rubbed all over with the oil three times a day 
for three days; then a bath was administered, fol- 
lowed by another anointing with the oil. Eucalyp- 
tus was also sprayed into the patient's mouth, nose 
and throat, and into the atmosphere of the room. 

(Sj.) 

The following is also commended for smearing on 
the skin after a warm bath : 



496 DIGEST OF EXTERNAL THERAPEUTICS. 

Acid. Carbolici, 3 1 - 

Ol. Eucalypti., 3^i — ^ v * 

Ol. Amygdalae, 

01. Olivse, - aa gviii. (T. 96.) 

Ichthyol: — A 5 per cent, lanolin ointment is useful, 
when simple oily applications have failed, for severe 
irritation of the skin which appears to cause restless- 
ness and high temperature. (T. 96.) 

For the cleansing and disinfection of mouth, 
pharynx, and nares, the following solutions are used, 
of which the first is preferred : 

Hydrogen Peroxide, 1—3. 

Hydrarg. Bichlorid., 1-10000. 

Carbolic Acid, 1-60. 

Liq. Sod. Chlor., 1-10. 

Boric Acid., 1-15. 

Sanitas, 1-40. 

Potass. Permang., 1—40. 

Sulphurous Acid, 1—10. 

Cleansing the nares and naso-pharynx may, it is 
said, prevent extension of suppuration to the eusta- 
chian tube. The nostrils should be sprayed with an 
alkaline solution and then with the following : 



Menthol, 


grs. xx. 


Eucalyptol, 


M. x. 


Paraffin, Fluid, 


ad. %i. 


Apply every 3 or 4 hours. 


(T- 97.) 



Hydrogen Peroxide: — Should constitute the sole 
local treatment for the otitis during the stage of in- 
flammation. (Gn.) 

Caustics: — May be required if there is much slough- 
ing of tonsils. First cleanse the parts, then apply 
such agents as Nitrate of Silver or Chinoline, 2-5 
per cent, in alcohol. (A. W.) 



SCIATICA. 497 



SCIATICA. 

The remedies mentioned for neuralgia, lumbago 
and chronic rheumatism, are applicable to this con- 
dition. 



SCORBUTUS. 

Antiseptic and astringent mouth washes, as found 
under stomatitis, are applicable to this condition. 

Nitrate of Silver: — One of the best applications for 
the ulcers. (Ty.) 

Hydrochloric Acid:— For applications to the gums, 
viz: 

Acid. Hydrochloric, Dilut., 3 1 - 

Mellis, 

Aq. Rosae, aa %i. 

Apply to gums three or four times a day. (Sn. ) 

Compresses saturated with Aromatic Vinegar or 
Spirits of Camphor are very useful for the ecchymosis 
and infiltration. (Rd.) 

Turpentine: — The undiluted oil painted on the 
gums hourly will cause the buccal haemorrhage and 
the haematuria to cease. (F.) 



SEBORRHCEA. 

When located on the scalp the scales must be first 
removed ; this may be accomplished if the scales are 
hard by soaking the scalp over night in Oil, and re- 
33 



498 DIGEST OF EXTERNAL THERAPEUTICS. 

moving the softened scabs with hot water and Cas- 
tile soap, or by shampooing with Spirits of Green 
Soap, using about a drachm with a sponge and con- 
siderable water ; after rubbing vigorously for a few 
minutes, cleanse with clear warm water, and dry 
with a soft towel. If the scalp is sensitive a good, 
toilet soap should be used. After the preliminary 
cleansing the remedy may be applied, viz: 

Carbolic Acid: — Most efficient; employ in the fol- 
lowing combination : 

Acid. Carbolici, Qi-^iss. . 

01. Ricini, 9ii. 

01. Limonis, %{. 

Aq. Cologni, gij. (Vn.) 

Resorcin : — In oil or vaseline, 5 per cent., or, 
Resorcini, grs. xx. 

Alcoholis, 3ii- 

Vaselini, 3vi. (T. 97.) 

Sulphur: — Regarded as one of the most satisfac- 
tory remedies ; a solution of 1 ounce to water 1 
quart, is used applied to the head daily (T. 97.) ; a 
solution of 1 drachm in sweet oil 1 ounce, rubbed in 
the scalp thoroughly nightly for a week, wrapping 
the head in a towel or wearing a night cap. During 
the second week the applications are made every 
other night, and after that reduced in frequency. 
(Ja.) Yleraingckx's solution, as described in the 
treatment of acne, is suitable for the disease when 
located on the face. 

Zinc Sulphide: — Duhring recommends the salt ob- 
tained by double decomposition, in the following lo- 
tion : 

Zinc Sulphate, 

Potassium Sulphide, aa 3ss. 

Rose Water, giij. 

Alcohol, 3iij-3vj. (F.) 



SEBORRHCEA. 499 

Mercurial Ointments: — The following is for use 
upon the scalp: 

Ung. Hydrarg. Nitrat., 5J~i v - 

01. Cadini, 3i. 

01. Olivae, 3ij. 

Lanolini, ^rv. 

Well rubbed in at night, and washed off in morning with borax, 
§ii, water, Oj; then a little almond oil rubbed in, or the ung. 
hydrarg flav. may used instead of the nitrate, with or without the 
oil of cade. (Ck.) 

An ointment of White Precipitate and Tar is as 
follows : 

Hydrarg. Ammon., 2>jss. 

Picis, Liq.,' ^ss. 

Ung. Petrolii, gi. (And.) 

Bronson recommends for private practice, as a sub- 
stitute for sulphur, the following: 

Hydrarg. Ammon., 9i~ij- 

Hydrarg. Chlor. Mitis, 9ij-iv. 

Vaselini, §i. (Ja. ) 

Hydrarg. Bichlorid.: — A useful ointment is as 
follows: 

Hydrarg. Bichlorid., grs. xij. 

Spts. Vini Rect., 3i. 

Glycerini (Price's), . 3ii- 

Aq. Destill., gv. (And.) 

For the face and scalp : 

Corrosive sublimate, grs. ij. 

Rose Water, 5i. (Sh.) 

Hydrastine: — An ointment of this remedy, recom- 
mended by Shoemaker, as follows : 

Hydrastinae Hydrochloratis, grs. v-xx, 

Naphtholi, 5 SS - 

Tr. Quaillaise, 3 SS - 

Tr. Hamamelidis, ^ss. (Sm.) 



500 DIGEST OF EXTERNAL THERAPEUTICS. 

Salicylic Acid (3 per cent, in castor oil), Solution 
of Chloral (1 drachm to the ounce), Tannic Acid (1 
drachm to the ounce of rice powder for the face) are 
other useful applications. (Ja., Kp.) The latter in 
the proportion of 3ss-3i, in an ounce of vaseline, 
is used for seborrhcea, oleosa, on the body and scalp. 

For irritation after removal of the scales, a plain 
dusting powder, viz : 

Acid. Salicyl., grs. x. 

Zinc. Oxide, 

Amyli Oryzae, vel. Maydis, aa %i. (B. H.) 

Used for a few days, 

For Seborrhcea of the Genitals, absolute cleanli- 
ness, dusting powders and antiseptic lotions, such 
as those of Ichthyol, and Bichloride of Mercury, are 
generally indicated. 

For Seborrhcea Oleosa use Sulphur, Oil of Cade, 
Ichthyol, or Resorcin in some penetrating media; 
the most effective of these is sulphur. 



DISEASES OF SIGMOID FLEXURE 
AND UPPER RECTUM. 

The employment of the Proctoscope and Sigmoid- 
oscope is of invaluable service. The ability to recog- 
nize various lesions in their incipiency, establishing 
the diagnosis beyond doubt, enables one by the 
prompt administration of appropriate treatment to 
attain excellent results. The pictures, as viewed 
through the proctoscope, are characteristic of neo- 
plasms, incuding carcinomata and fibrous and ade- 
noid polypi, and such non-surgical diseases as simple 
acute catarrh, hypertrophic catarrh, and atrophic 



SPERM ATORRHCEA. 501 

catarrh. In the latter conditions the treatment con- 
sists chiefly in copious Irrigation with saline or mild 
antiseptic solutions ; in cases of atrophic catarrh a 
5—10 per cent, solution of Argonin has been found to 
he particularly efficient, while in cases of hyper- 
trophic catarrh the aqueous fluid extract of Krameria 
is regarded as almost a specific. (N. Y. M.J ., 2, 7, 
98.) 



SPERMATORRHOEA. 

Sleeping in the dorsal position should, if possible, 
be avoided as it is apt to induce pollutions. A 
knotted towel tied around the waist, or a block of 
wood held in position by tapes and placed in the 
small of the back, will cause the patient to awaken 
when he turns. 

Cold Baths: — A general cold bath, preceded by 
light calisthenics or massage, is often beneficial in hy- 
peresthesia cases with frequent pollutions. In the 
later periods, with anaesthesia of the parts, cold sitz 
baths, cold sprays to the genitals, or cold shower 
baths, will give good results. 

Hot Sitz Baths: — In the hyperaemic stage baths at 
a temperature of 105° for ten minutes at bed time 
are indicated ; after the bath the part should be care- 
fully dried with a soft towel, avoiding all friction. 

Steel Sounds: — If there is much prostatic irrita- 
bility the passage of a full-sized steel sound every 

*Note. — This entire article, with the exception of the paragraph 
on "Stripping of the Seminal Vesicals," is an abstract of the 
treatment of this disorder, as described by Dr. Bukk G. Carleton, 
in his work on the subject. See Cln. in reference key. 



502 DIGEST OF EXTERNAL THERAPEUTICS. 

third day or once a week is of benefit. It must not, 
however, be allowed to remain in the canal as ad- 
vised for urethral dilatation, as unpleasant symp- 
toms may be caused. 

Stripping the Seminal Vesicles:- — This method is 
intended to reestablish the natural expulsive power 
of the seminal vesicles and ampullae by the removal 
of inflammatory deposits. Fuller, who originated 
this plan of treatment, described it as follows: " The 
patient, whose bladder must be full, is directed, while 
standing with the knees straight, to bend the body 
forward at right angles ; the operator now intro- 
duces the forefinger of one hand into the rectum, 
while with the other firm counter pressure is made 
over the pubes. The end of the forefinger will, in all 
ordinary cases, reach beyond the posterior margin of 
the prostate, and the bodies of the vesicles can be de- 
tected, one on each side of the posterior border of the 
gland. Only the lower half can be felt in ordinary in- 
stances. Firm pressure is made by the tip of the in- 
dex finger, reaching as far back as possible. The fin- 
ger tip should be slowly and firmly drawn along the 
line of the vesicle, the manoeuvre being aided at the 
same time by counter-pressure over the pubes. The 
procedure may be performed several times on each 
vesicle. In this manner if the sac is distended some 
of the contents can be pressed into the prostatic 
sinus. After the manipulation, the urine should be 
voided in order to ascertain how much has been ex- 
pressed. This treatment should not be repeated more 
frequently than once in four days. If applied too 
often, or with too firm pressure, active symptoms 
may be induced, even causing acute epididymitis. 
(Ful.) The finger of the operator should be pro- 



SPERMATORRHOEA . 503 

tected by a rubber tip. Evidence of acute inflam- 
mation, the presence of pus in the urine voided after 
manipulation or increase of tenderness are contra- 
indications. 

Rectal Psychophore: — Excellent results are ob- 
tained in the same class of cases that call for the pre- 
ceding method. Ice water, or alternating hot and 
cold water, should be used by means of Carleton's 
psychophore. The psychophore, alternated every 
fifth day with Fuller's method, will give very satis- 
factory results. 

Intra-Vesical Douches: — These are indicated for 
hyperamiia or catarrh of the posterior urethra or 
when the bladder is involved to any extent. Valen- 
tine's modification of Janet's method may be used, 
or preferably a No. 12 F. catheter, sterilized, may be 
introduced into the bladder after the urine is evacu- 
ated, and 4—6 ounces of an antiseptic fluid injected 
with Janet's antiseptic syringe. As soon as there 
is a sensation of fullness the catheter should be 
withdrawn and the bladder emptied. The antiseptic 
solutions, which act favorably, are Formalin, 1— 
1000-10,000; Bichloride of Mercury, 1-12,000- 
20,000; Nitrate of Silver, 1-2000-8000; Potass. 
Permang. 1-2000-10,000. Bladder irrigations 
should be administered after manipulations of the 
ampullae, never before. 

Deep Urethral Douches: — Are of service for pos 
terior urethral irritation. Janet's antiseptic vesical 
syringe, or an ordinary fountain syringe, attached to 
a catheter maybe used, injecting from a few ounces to 
a pint of the selected solution every one to four days. 

The solutions for this purpose are : 

Nitrate of Silver, 1—500—1000. 



504 DIGEST OF EXTERNAL THERAPEUTICS. 

Formalin, 1-1000. 

Thalline Sulphate, 1-1000. 

Iodoform vel. Vaseline Emulsion, 5 per cent. 

Instillations: — Often of advantage; they sometimes 
act best when the applications are made through a 
soft rubber catheter, cut to 8}4 inches in length, so 
that the eye of the catheter when fully introduced 
will be located in the centre of the prostatic urethra, 
then with a Taylor's minim syringe from 10 minims 
to a drachm of the selected solution can be intro- 
duced without pain or injury. The action of the 
compressor urethrae muscle will prevent the flow of 
the solution from and into the urethra and tend to 
cause it to pass backward into the bladder. The 
Keyes-Ultzmann syringe should be employed for 
stronger instillations. The bladder should be quite 
full at the time in order to subsequently dilute the 
solution by the passage of the urine through the ure- 
thra. 

The following strong solutions are recommended : 
Nitrate of Silver, 1—10 per cent; Sulphate of Cop- 
per, 10 percent; Tr. Iodine, Carbolic Acid, Borogly- 
ceride, equal parts. 

When these are employed commence with one of 
one-tenth the strength that which it is intended to 
finally administer ; at the first application apply 10 
minims and gradually increase the strength at each 
sitting, repeating the application every fourth day 
until the desired strength or satisfactory results have 
been obtained. 

In making instillations of weak solutions the blad- 
der should be emptied and the solution placed in the 
posterior portion of the urethra, allowed to flow 
back into the bladder and voided, thus affording a 



SPERMATORRHOEA. 505 

double application. The weaker solution for instilla- 
tions are those which may be also employed for 
irrigation, viz : 

Nitrate of Silver, 1-2000-8000. 

Potass. Permang., 1-1000-10,000. 

Mercuric-Bichloride, 1-10,000. 

Zinc Sulpho-Carbolate, 1-1000-3000. 

Carbolic Acid, 1-100-500. 

If urethral instillations cause too much reaction 
they must be reduced in strength, preceded by Cocaine, 
or discontinued. When nitrate of silver solutions 
cause pain it may be relieved by douches of sodium 
chloride. 

Urethral Psychophore: — With water at 40°-50°, 
applied for five or ten minutes every day, or every 
third day. This is indicated when there is hyperes- 
thesia of the posterior urethra, with or without im- 
potence, especially when the urethral discharge is free 
from pus. When there is anaesthesia and loss of tone 
hot water at a temperature of 105°— 110° may be 
employed with good effect. A psychophore of suffi- 
cient size to fill the urethra should be used and placed 
in such a position that its three distal inches come in 
exact relation with the local lesion, the remainder of 
the instrument not transmitting either heat or cold. 

Dilafation of the Prostatic Urethra: — Diseased con- 
ditions in this part may necessitate this procedure in 
order to empty the follicles of the prostate. A pros- 
tatic dilator should be used. Carleton's instrument 
for this purpose will afford very satisfactory results. 
When it is desired to dilate the bulbous urethra at the 
same time Kollmann's antero-posterior dilators will 
answer well. Prostatic dilatations should always 
be preceded by urethral irrigation and followed by 



506 DIGEST OF EXTERNAL THERAPEUTICS. 

douching of the bladder. It should not be repeated 
more frequently than once in ten days. 

Ichthyol Suppositories:— Recommended for the ab- 
sorption of inflammatory products in the prostatic 
and pro-prostatic tissues. 

Electricity: — Faradism has good effects; the paste 
brush may be applied to the genitalia, or King's rec- 
tal electrode may be employed. 

Galvanism may be used by applying the positive 
pole to the lumbar or sacral region and the negative 
to the parts by means of the ordinary electrode ap- 
plied externally, or the conical steel sound. In hy- 
peraemic conditions of the urethra the ordinary sound 
forms an excellent electrode. A current of 1 or 2 
milliamperes may be administered for not longer 
than one or two minutes. Newman's sound will be 
required when the general condition of the urethra 
is relieved, but hyperesthesia spots remain; under 
the conditions three milliamperes may be given. 

Outdoor exercises and sports are generally advisa- 
ble. Bicycling, however, should be under medical 
supervision ; a properly constructed saddle, that is, 
one which does not permit pressure on the perineum, 
is essential. Over fatigue must be avoided and the 
erect posture maintained in riding. Horseback riding 
is not to be permitted. (H.) General Massage will 
often be found of benefit. 



SPRAINS. 

Heat and Cold: — In regard to the use of these 
agents, in which there appears to be some diversity of 
opinion, the following indications are given by Mr. 
Tubby in the Practitioner, April, 1897 : 



SPRAINS. 507 

If the injury is seen within the first two or three 
hours apply cold vigorously by pouring on cold wa- 
ter or by the use of ice or spirit lotions ; this should 
be kept up for ten or fifteen minutes ; then wrap 
the limb in lint soaked in cold water or spirit lotion, 
place it in proper positron and firmly bandage. If 
seen later hot applications should be frequently 
made, either hot water or hot vinegar and salt. Keep 
the joint at rest and maintain steady pressure with 
bandages. Before this, especially if there is much 
swelling, use Friction, the object of which is to empty 
the lymphatics of a certain amount of coagulated 
lymph. In rubbing it is alwa}^s advisable to com- 
mence at the parts most distant from the joint, thus 
emptying the lymphatics at that part first. Not a 
few writers advocate the immediate use of hot appli- 
cations as soon as the injury is seen. 

Rubber Bandage and Hot Water: — The follow- 
ing plan is recommended for the relief of pain: Im- 
merse the part in hot water, increasing the tempera- 
ture until the patient becomes accustomed to the heat 
and the pain becomes less. The next step is the appli- 
cation of a rubber bandage, which is to be applied im- 
mediately after the discontinuance of the hot water. 
If there is laceration of ligaments, or contusion 
of the parts, a wet compress may be applied, over 
which the bandage is placed. This may be left on for 
twenty-four hours. In injuries of the knee it may be 
kept applied for several days. It should be put on 
hot and changed several times a day. If the skin be- 
comes thickened or white as from a poultice omit the 
compress. The bandage, however, must be worn 
constantly, and the compress reapplied should pain 
succeed its removal. (Hel.) 



508 DIGEST OF EXTERNAL THERAPEUTICS. 

Aspiration: — In severe injuries when there is much 
enlargement, and a great amount of blood has poured 
into the joint, it should be removed with the aspirat- 
ing needle under careful antisepsis. (A.) 

Strapping: — The method of Gibney and Cotterell is 
recommended both in early and late stages, viz : 

For sprain of tarsus and ankle, take strips of plas- 
ter one and a half inches wide, and eighteen long ; first 
strip starts at juncture of middle and upper third of 
leg, outer or inner side. Apply close to tendo-Achilles, 
carrying it across sole of the foot to the base of 
great or little toe ; several strips are applied, covering 
inner or outer side of ankle. A strip is then applied 
with its middle at the point of the heel. The ends 
come to a point on the foot at the junction of the 
metatarsal bone and tarsus. A number of these as- 
cending strips are applied in an imbricating manner 
until the entire joint is covered. These strips should 
be applied so as to meet in front of the ankle and 
make circular constriction. After strapping apply a 
bandage, and the patient is allowed to walk. (W. 
C.) This method is now much used, being highly en- 
dorsed. 

Splints and Plaster of Paris: — In severe sprains re- 
duce misplaced tendons, apply hot or cold water, and 
later apply splints or plaster of Paris as in fractures. 
After wearing these for a time they should be removed 
and massage employed. (W. C.) 

Bandaging: — Should be used in all forms unless 
plaster or splints are employed. Usually sufficient in 
mild cases after applying compresses or lotions. 
(W. C.) 

Compression: — Wrapping the joint in plenty of cot- 
ton and bandaging somewhat firmly, will often prove 
effective. (A.) 



SPRAINS. 509 

Arnica: — Very useful, the tincture of the root is to 
be preferred, 1 part to about 5 of water, apply with 
compress and bandage. 

Lead and Opium Wash — An old remedy of great 
efficacy. The formula is as f ollows : 

Tinct. Opii, 

Liq. Plumbi Subacetat. , Dil., aa ^ii. 

Aquae, q. s. ad. Oj. 

Saturate a compress, squeeze out excess, and apply over all a 
roller bandage. 

In spite of criticism, this remains one of our most 
effective remedies for this form of accident. 

Massage: — Excellent results have been obtained in 
all forms of sprains and contusions, and in the inju- 
ries to the soft parts consequent upon dislocations. 
Applications may be made immediately or very 
soon after the injury. Dr. J. Robie Wood recom- 
mends that in sprains of the ankle the part be placed 
in hot water, and at the same time massed with an 
upward movement, then adhesive strips, according 
to the method of Gibney and Cotterell, are to be ap- 
plied. Massage is also of great efficacy after the 
subsidence of acute symptoms, -when much stiffness, 
pain and loss of power remain, constituting under 
this condition our most important measure for the 
restoration of the limbs. 

Ammonia: — The following combinations form use- 
ful liniments : 

Aq. Ammoniae, 
Fid. Ext. Arnicas, 
Lin. Saponis, 

01. Terebinthinae, aa ^ii. 

Rub in several times a day. 



510 DIGEST OF EXTERNAL THERAPEUTICS. 

Lin. Ammoniae, ^ii. 

Spts. Chloroformi, ^i. 

Lin. Menthol., ^ii. 

Tr. Opii, li. 
Rub well over the surface. ( Sm. ) 

Hamamelis: — The aqueous extract, somewhat di- 
luted with water, forms a most useful remedy, apply 
with compresses, and cover with rubber protectors. 

Ichthyol: — Applied with friction, and massage is 
said to sometimes give satisfactory results. (Sm.) 

Alcohol: — Equal parts with water, forms a useful 
evaporating lotion. (N.) 

Tr. Rhus Tox. or Tr. Ruta, diluted, may be used 
with good effect after hot water applications. (Rd.) 
The various liniments, viz: Aconite, Belladonna, 
Camphor, Chloroform, Soap, and Turpentine are all 
of use. 



STRANGURY. 

Electro- Static Current to spine and hypogastrium 
has been very effective. (CI.) Warm Sitz Baths, 
Hot Fomentations to perineum. Suppositories con- 
taining Opium, Belladonna or Hyoscyamus. (Bl.) 



STRICTURE, SPASMODIC. 

Hot Sitz Baths and Hot Fomentations: — If not re- 
lieved, use the Catheter. When this is not possible, 
anaesthetize and use catheter, or Aspirate to give im- 
mediate relief, assuring the patient that the next uri- 
nation will be normal. (CI.) Morphia, hypoderm- 
ically, may be necessary. 



STOMATITIS. 511 



STOMATITIS. 

The treatment of the different varieties of this 
disease resemble each other so closely that they 
will be considered collectively. Particular atten- 
tion should be directed toward securing an aseptic 
condition of all which comes in contact with the mu- 
cous membrane of the mouth. Every means should 
be employed to prevent infection. Nurses should ex- 
ercise care in cleansing the infant's mouth, and avoid 
wounding the mucous membrane. In health antisep- 
tic mouth washes are not necessary, but sterilized 
water should be used for cleansing. Gentle friction 
with a soft cloth is advised in thrush for the removal 
of the exudate in order to permit of the more perfect 
action of local remedies ; alkaline solutions effect this 
purpose also. (Gn.) 

Boric Acid or Borax: — 1-3 percent., or stronger so- 
lutions, constitute the most frequently employed and 
generally effective remedies in cases of the catarrhal, 
aphthous, and membranous (Thrush) variety. (Hit.) 
Borax with honey or glycerine is used. (Rd.) 

Potass. Chlorat.: — gi, to water giv, is one of the best 
local remedies for general use. (B.) In the follicular 
and ulcerous variety its topical effect may be ob- 
tained by giving it internally, and not allowing the 
patient to swallow any water for some little time 
after. The dose is a drachm hourly of a solution of 
8 grains to 5 ounces of glycerine and water. (Jac.) 

Nitrate of Silver: — 1-500-1000, may be brushed on 
in the catarrhal forms when the tongue and mucous 
membrane are dry. In the aphthous variety, when 



512 DIGEST OF EXTERNAL THERAPEUTICS. 

there is a tendency to superficial ulceration, a solu- 
tion of 1—50 may be applied gently. Weaker solu- 
tions, as 1-500, applied daily are serviceable in Bed- 
nar's aphthae and thrush. (Jac.) 

Potass. Permang.: — When a stronger disinfectant 
is required, solutions of 1-250-500 with four or five 
applications daily. (Jac.) 

Alum: — Local applications of solutions constitute 
one of the most reliable remedies in relaxed conditions 
of the mucous membrane. The use should not be pro- 
longed on account of destructive action on teeth. (Al.) 
The powders or a solution sss, water 3i, are used . (Ty . ) 

Sulphurous Acid: — Strong or diluted, as a spray. 

Bismuth Subnit.: — As a dusting powder directly to 
the ulcers, or 3i to glycerine %i. 

Tr. Hydrastis: — ^ii, glycerine ^ii. 

Carbolic Acid: — 1 per cent, solution, as a mouth 
wash, or the pure acid to ulcer as an anaesthetic and 
cauterant. 

Naphthalin: — 5—10 per cent., as a dusting powder. 

Labarraque's Solution in the following.: 



Liq. Sod. Chlorinat., 




Tinct. Myrrh., 


aa, ^ss. 


Aq. Rosfe, 


Sji, 


Aq. Destil., 


^vi 



(Al.) 

Pyoktanin Blue:— 1-500. 

Sod. Salicylic: — giss, rose water %i. 

Tannin: — Especially when the gums are spongy, 3i, 
with aq. rosae gii, aq. destill. gvi. 

Sod. Sulphite: — ^i, water §i. 

Tr. Iron and Glycerine: — Equal parts, painted on 
ulcerations forms a good application. 

Myrrh: — 31, water gvi, a little boric acid, borax, or 
a few drops of carbolic acid or thymol may be added 
with good effect. 



SUNSTROKE— PROSTRATION BY HEAT. 513 

Lemon Juice: — Properly diluted, forms an agree- 
able mouth wash. 

Resorcin: — As a dusting powder. 

Copper Sulphate: — Grs. x, water %i in chronic re- 
current forms ; the ulcers may be touched with the 
pure crystals. 

Hydrochloric Acid: — Gtts. v, glycerine ^ss. 

Baptisia: — The decoction as a mouth wash. 

MERCURIAL STOMATITIS: 

The local treatment of this condition does not ma- 
terially differ from that of other forms. (Ty.) The 
reader is, therefore, referred to the previous article. 
The remedies to which preference should be given are 
Chlorate of Potassium, Alum, Myrrh, Tannin and 
Labarraque's Solution. 



SUNSTROKE— PROSTRATION BY 

HEAT. 

Cold Baths and Affusions: — Severe cases with high 
temperature should be treated with ice baths, plac- 
ing the patient in a tub of water with ice floating in 
it, bath being at a temperature of about 44°. When 
baths are not convenient or deemed expedient, strip 
the patient, place ice on his head, and pour cold wa- 
ter over body. Care should be taken not to reduce 
temperature too fast or too low ; one of 102° should 
be a signal for the withdrawal of cold. After the 
bath or cold affusion the patient should be dried, 
removed to a cot, an ice cap placed on the head and 
the body lightly covered. He should be allowed to 
34 



514 DIGEST OF EXTERNAL THERAPEUTICS. 

rest until an exacerbation indicates the need for a re- 
newal of cold applications. (An.) 

Cold Water Enteroclysis: — Useful in extreme cases 
when temperature remains very high ; administer 
about 2 quarts as often as required. (Sj.) 

Quinine: — Subcutaneous doses of 3% grs. of the bi- 
chloride ; repeat in half an hour. (F.) 

Counter-Irritation: — To the nape of the neck when 
there is evidence of meningeal irritability. (Sj.) 

Morphia: — Subcutaneously, is of benefit in cases 
characterized by pallor of the face and weakness of 
the heart, that is, heat exhaustion. (B.) 

Ether first, then Caffein, hypodermically, for col- 
lapse. (Sj.) 

Venesection: — May be indicated in apoplexical 
cases. (An.) 

Hot Baths: — If after reduction of the fever diapho- 
resis does not occur a bath may be administered, and 
possibly a hypodermic of pilocarpine in urgent cases. 
(An.) 

Artificial Respiration: — Should be employed when 
there is collapse, and kept up until other measures 
have had time to act. (An.) 



SYCOSIS COCCOGENICA. 

Treatment will vary according to the stage of the 
disease. When acute, emollient and soothing applica- 
tions will be indicated, together with cutting the 
hair as short as possible and the removal of scales 
and crusts by means of oils and fomentations. 

Ammoniated Mercury: — When papules are begin- 
ning to appear two parts of the ointment with one 



SYCOSIS COCCOGENICA. 515 

of vaseline are sometimes effective in arresting the 
progress of the disease. (Ck.) 

Shaving: — There is some divergence of opinion in 
regard to the utility of this measure ; some writers, 
while admitting that it enables the remedy to reach 
the skin with greater ease, claim that it it tends to 
spread the infection ; it is moreover painful to many. 
On the other hand, some dermatologists insist that 
it is essential to successful treatment, advising it 
every second or third day. When done for the first 
time, the hair should be clipped close and a poultice 
applied to soften the crusts. The lather from a car- 
bolic shaving stick applied and left on skin over 
night, is, according to Crocker, a useful adjunct. 

Poultices: — If there is much oedema and severe in- 
flammation, warm fomentations will prove of bene- 
fit; in some cases, however, cold starch poultices give 
better results. (Ja.) A poultice made with bread 
and dilute lead water, applied cold, is recommended 
in preparing the face for shaving. 

Epilation: — When there are pustulations and the 
beard can not be shaved, each affected hair must be 
pulled out and the follicles cleansed with a weak anti- 
septic lotion, and an ointment of resorcin or subli- 
mate applied. This measure should only be used 
when the roots of the hair are loosened. (Ck.) 

Lotio Nigra: — Of service when the disease is acute, 
and there is much pain and swelling. It may be ap- 
plied every two or three hours, followed each time by 
oxide of Zinc Ointment, applied by means of the fin- 
ger, or spread upon pieces of linen, and bound upon 
the parts. (Sh.) 

Bichloride of Mercury: — A lotion of 2 grains to the 
ounce of water after epilation. (Rd.) 



516 DIGEST OF EXTERNAL THERAPEUTICS. 

Lead 'Water and Laudanum, weak solutions of 
Witch Hazel, Zinc, and Lead Acetate form useful, 
sedative and astringent lotions for the reduction of 
swelling and inflammation. (Sh.) 

The following wash is also of service in the acute 
stage : 

Pulv. Zinc. Carb. Prsecip., 

Pulv. Zinc. Oxid., 

Glycerin., 

Liq. Plumb. Subacetat., Dil., aa ^ij. 

Aq. Rosae, ^vijss. (Vn.) 

Oils: — When there is a good deal of crusting, these 
preparations are indicated, viz: Oil of Ergot, Olive 
Oil with fluid Mercury Oleate, Cod Liver Oil alone 
or combined with Arrowroot, Zinc or Lead Carbon- 
ate, Opium, Arnica, or Belladonna lightly pencilled 
over the surface. (Sh.) 

Salicylic Acid: — 2 per cent, solutions in olive oil ex- 
cellent for softening the crusts ; apply for a day and 
a night ; then wash with soap and water. This may 
also be applied at night to prevent drying when lo- 
tions are used during the day. An ointment of 10— 
15 grains to the ounce of Lassar's paste forms a 
stimulating application indicated when there is pus- 
tulation. (B. H.) 

Lassar's Paste, Zinc Ointment or Cold Cream, 
preceded by Hot Water, sopped on for five or ten 
minutes twice a day, constitute excellent soothing 
remedies for the acute stage, especially when the 
face is shaved. The following are also useful appli- 
cations after shaving : 

Zinc Oxide, 

Zinc Carbonate, aa gi. 

Rose Ointment, ad. ^ i. 



SYSOSIS COCCOGENICA. 517 

Or, 

Zinc Oxide, £i. 

Linseed Oil, %i. (J a -) 

Ointments: — Among the most serviceable in earlier 
stages are: Zinc, Lead, and Bismuth Oleates (alone 
or combined with other agents), and Calomel (1Q 
grains to the ounce of cold cream or rose ointment). 
Resorcin, Ichthyol, or Boric Acid may also be 
brought into requisition. (Sh.) 

Diachylon Ointment: — Is excellent in the acute 
forms ; a few grains of Camphor may be added. (Sh.) 
It may also be advantageously combined with other 
remedies, as Oil of Cade or Zinc Oxide, the latter 
being indicated when the disease has become chronic 
and requires stimulation. (B. H.) 

Provan's Tragacanth Paste: — Recommended by 
McCall Anderson, is as follows : 



Tragacanth, 




Glycerine, 


aa ^ ss. 


Biborate of Soda, 


£SS. 


Distilled Water, 


q. s. . 


The following combinations are 


useful : 


Powdered Poke Root, 


Si- 


Menthol, 


grs. x 


Lanoline, 




Oxide of Zinc Ointment, 


aa ^ss. 


Also: 




Acid. Carbolic, 


grs. v. 


Bismuth. Subnitrat., 




Ung. Hydrarg Ammoniat., 


aa 5ii. 


Ung. Aq. Rosse, 


3v. 



(Sh.) 



(T. C. Vol. IV. ) 

Mercurial Ointments: — Suitable when stronger 

preparations are demanded. They may be used when 

the eruption is confined to one or two points, and in 



518 DIGEST OF EXTERNAL THERAPEUTICS. 



- - 



subacute and chronic cases. Combined, as in the fol- 
lowing, with sulphur, they are effective : 

Red Sulphate of Mercury, i part. 

Sulphur Sub., 24 parts. 

Lard, 75 parts. (B. H.) 

Sulphur: — Useful when disease becomes more 
chronic, and inflammation is less. The following 
wash is for subacute cases, and sometimes succeeds 
when other remedies fail : 

Sulphur. Praecipitat., ^ii. 

Pulv. Camph., grs. x. 

Pulv. Tragacanth., £)j. 

Aq. Calcis, ^iv. (Vn.) 

Pyrogallol: — A 2 per cent, solution in alcohol 
painted on the affected part twice a day and the ap- 
plication at night of the following ointment is rec- 
ommended by Viell : 

Sulphur Lac., 

Alcohol., 

Aq. Rosse, aa £i. 

Mucil. Gum. Acaciae, M. xx-xxx. (Ja.) 

,3-Naphthol: — Kaposi recommends the following 
combination to which sulphur may be added as fol- 
lows : 

y 3-Naphthol., 1 part. 

Spts. Sapo. Vir., 25 parts. 

Alcohol, 50 parts. 
Balsam Peru, 2 parts. 

Sulph. Lotion, 10 parts. (Kap.) 

Green Soap: — When the affection is of long stand- 
ing, and there is much infiltration, a small portion, 
rubbed on with a little water, and then washed off, 
followed by diachylon ointment, is a valuable method 
of treatment . ( Vn . ) 



SYNOVITIS. 519 

In addition to the employment of these remedies, 
it is often of the utmost importance to open various 
lesions that may be present, and to puncture the sur- 
face thoroughly, thus relieving the enlarged and con- 
gested blood vessels, allowing stagnated blood to 
circulate, the effused serum to escape, and preventing 
the formation of pus. If there is much thickening of 
skin depletion is followed by decidedly beneficial re- 
sults. 

Massage and Static Electricity: — Serviceably em- 
ployed when debility is marked. (Sh.) 

The rhinitis, which is often present, should be 
treated with antispetic douches. After a cure has 
been effected, the patient should be kept under obser- 
vation for some time. He should be instructed to 
bathe the face daily in hot water, and apply some 
protective ointment. Ointments, when used, should 
be bound on tightly. 



SYNOVITIS. 

ACUTE SYNOVITIS: 

Rest in the position of greatest comfort; Mild Ex- 
tension; Cold application by means of Ice Bags or 
Leiter's Coil (Tre.); Heat may be substituted for cold 
if the latter is not agreeable to the patient ; use the 
hot water bag, or immerse the parts in hot water. 
(W.) 

The following is an anodyne ointment; apply twice 
daily with a brush : 

Morph. Sulph., grs. viii. 

Oleate of Mercury (5-10 per cent, ointment), %i. 



520 DIGEST OF EXTERNAL THERAPEUTICS. 

Lead and Opium Wash: — Applied hot, forms one 
of the best applications. (Tre.) 

Alcohol: — Diluted with water, equal parts, forms 
an excellent evaporating lotion. 

Splints: — To keep the parts at rest, should be used 
in cases arising from traumatism. (Tre.) 

Aspiration: — If there is much tension, with extreme 
pain, and the capsule and ligaments are in danger of 
being overstretched ; to prevent permanent damage 
the joint should be aspirated under complete anti- 
sepsis. (W.) 

Compression: — Equal pressure as firm as can be 
borne, covering the joint with cotton and bandag- 
ing, is useful after the more acute symptoms have 
subsided. (A.) 

Carbolic Acid: — In subacute cases, when aspiration 
has failed to relieve, a permanent cure can ordinarily 
be effected by injecting through a trocar 2—3 
drachms of a 5 per cent, solution. (Pk.) 

Hamamelis or Vinegar are used. 

CHRONIC SYNOVITIS (Compare Chronic Rheuma- 
tism): 

Rest: — Of the part is essential. 

Iodine: — The tincture, painted on the joint, has long 
been used. After its application Ashhurst recom- 
mended : 

Ung. Hydrarg., 

Ung. Belladonnae, aa %i. 

The following is also for painting on the part : 

Iodi, 3 ss - 

Potass. Iodid,, ^i. 

Aquae, ^vi. (Sti.) 



SYPHILIS. 521 

Ichthyol: — 20-50 per cent, in lanolin, rubbed on the 
joint, which in bound in cloths covered with the same 
ointment, is sometimes attended with good results. 
(M.H.) 

Mercurial Ointment: — Was used by Dupuytien in 
the form of inunctions, viz : 

Ung. Hydrarg., gii. 

Pulv. Ammon. Chlorid., gi. (Sn.) 

Carbolic Acid: — An injection of 10 minims of a so- 
lution of grs. viii, distilled water ,li, is used, repeating 
every third day. (Sn.) 

Pressure by an elastic bandage, Friction, Massage, 
are all of service. (Pk.) 

Aspiration and Irrigation of the Capsule and Joint: 
— Are m ost eff ectu al meth od s . Strict antisepsis should 
be followed, shave the joint and wash it thoroughly 
with ether, then with sublimate 1-3000, and apply 
an antiseptic rubber bandage around the parts, leav- 
ing a small space exposed for the insertion of the 
needle. An aspirator should be used for the with- 
drawal of the fluid, after which the capsule should be 
filled to distension with a sublimate solution of 1— 
10,000 ; then the same is withdrawn, and an antisep- 
tic dressing applied, followed by plaster of Paris 
splints or some fixed apparatus. (W.) 

Opening the Joint and Removal of Hypertrophied 
Tissue is followed by excellent results. (Tre.) 



SYPHILIS. 

Mercury: — The methods of administration other 
than by the mouth of the cardinal remedy for this 
disease are by Inunction, Subcutaneous Injection, 
Fumigation, and Calomel in Traumaticin. 



522 DIGEST OF EXTERNAL THERAPEUTICS. 

Inunction: — This should be restricted to those cases 
where there is faulty digestion, such as catarrhal 
conditions of any part of the alimentary canal, 
where the internal administration of the mercurial 
preparations has not been attended with results, 
and where the conditions demand immediate and di- 
rect action; in the latter instance it will be found in- 
valuable. 

The ordinary Ung. Hydrarg. of the U. S. P. is gen- 
erally used. It is very important that it should be 
freshly prepared ; about 40 grains constitute the 
dosage for one application. The body is usually 
anointed at six sittings, as follows: The back and 
neck, chest and abdomen, right arm and left arm, 
right leg and left leg, avoiding the scrotum. Hairy 
parts should be avoided. If it is not possible, they 
should be shaved. Should that be objectionable the 
Ung. Hydrarg. Ammon, may be substituted. The in- 
unctions are best administered by a professional 
masseur. The region should be first washed with 
soap and carbolized water. (CI.) 

Between the first and second applications there 
should be an interval of about five days or less; be- 
tween the second and third, five to ten days ; between 
the others, about two weeks. Hot baths should be 
given during these intervals. This method of admin- 
istering mercury is not always well borne ; some are 
easily salivated, while others may suffer from eczema 
and erythema. Patient should be carefully watched 
to see if any untoward effects are produced requiring 
a decrease or discontinuance of dose. (CI.) 

A 20 per cent, ointment of the Oleate of Mercury 
may be used ; it has the advantage of being less dis- 
agreeable than the ordinary mercurial ointment, but 



SYPHILIS. 523 

being more easily absorbed it should be applied with 
a brush and not rubbed in, at least not so vigorously. 
(F.) 

Subcutaneous Injection: — There is divergence of 
opinion among writers in regard to the advantage 
of the hypodermic administration of mercurj". Ac- 
cording to Martineau, its action is more rapid, more 
effective, and more energetic than any other hereto- 
fore proposed. (B.) On the other hand, Goodno 
denies that it has any especial advantage. Carleton 
recommends it as beneficial for many cases, but not 
suitable for routine practice. 

The syringe used for mercurial hypodermic dosage 
should have rubber mountings ; both needles and the 
point of injection should be rendered thoroughly 
aseptic. The subcutaneous areolar tissue of the back 
is the best point for injection. Irritation may be 
caused, and in some instances, when given improperly , 
abscesses may be produced. Of the mercurials rec- 
ommended for this form of administration the fol- 
lowing have been selected : 

Hydrarg. Bichlorid.: — A simple solution in distilled 
water, 4 grs. to the ounce ; 10 minims for dose 
daily, increased, minim by minim, until 50 have been 
given, or until the physiological effects have been 
produced. The moment the least mercurial impres- 
sion is made the dose must be reduced. 

In place of small doses, Shoemaker, of Philadel- 
phia, has used injections of V^-Vz grains in the gluteal 
region two or three times a week. This method he 
regards as especially adapted to these subjects, and 
those with broken-down constitutions, where it 
affords the most positive way of limiting or curing 
the disease. 



524 DIGEST OF EXTERNAL THERAPEUTICS. 

The following solution is also employed : 

Hydrarg. Bichlor., grs. xv. 

Sod. Chlorat., 3ss. 

Aq. Destill., ^ ii j . 
Inject x-xv minims every second day. (Sm.) 

Albuminate of Mercury: — Prepare as follows: 
Corrosive sublimate 15 grains, distilled water 5 
drachms ; to this solution add 5 drachms of white of 
^gg, shake thoroughly, and incorporate V2 drachm of 
sodium chlorate and 2 ounces of distilled water. 
This mixture is again well shaken, then filtered and 
sufficient water added to make 4 ounces. The dose 
is 15-30 minims. (B.) 

Amidopropionate or Alaninate of Mercury: — Is 
an eligible mercurial for subcutaneous use, as it does 
not cause irritation at the site of injection. The dose 
in syphilis is T^—Vk grs. daily. (F.) 

Asparagin Hydrargyrate:— Used recently with ex- 
cellent results; dose, £ gr. (F.) 

Fumigation: — One of the earliest methods of ad- 
ministration, is somewhat less reliable than inunc- 
tions, and more easily productive of salivation. It is 
useful in secondary and tertiary cases with ulcera- 
tions, when the eruptions are diffuse, or when the in- 
ternal administration of mercury is not well borne 
and the patient is unwilling to submit to inunctions. 
It is not adapted to continuous use. 

Various mercurials are employed, the Sulphuret, 
Iodide, and Calomel; the latter is best, and is gener- 
ally selected. From 20-40 grains are put in a cup of 
water and placed over a spirit lamp, the patient is 
wrapped in a blanket, and so arranged that the va- 
por of the mercury will fall upon the skin under the 
blanket; or a special apparatus may be employed. 



SYPHILIS. 525 

Commence with 20 grains and gradually increase, 5 
grains at a time, administering every second day, 
watching the gums for any sign of salivation. After 
the fumigation, the patient should retire to bed to 
avoid taking cold. 

Never give the fumigations after a meal or continue 
their use for more than a month or two. (CI.) 

Calomel and Traumaticin : — Favorable results have 
been reported from the following : A bath is given, 
then a 25 per cent, mixture of calomel and traumati- 
cin is painted on the patient's back or, if there are 
syphilitic manifestations on the skin, it is applied over 
those surfaces. This method is peculiarly well 
adapted to cases when the internal administration of 
the drug is not well tolerated, and to hereditary 
syphilis in children. It has the double advantage 
of producing both local and general effects as well as 
being neat and cleanly. (F.) 

SYPHILIS OF THE LARYNX: 

The local treatment of simple chronic laryngitis is 
generally applicable to this condition. In erythema- 
tous forms of inflammation, if serious, the same 
treatment as recommended for acute catarrhal laryn- 
gitis should be employed. (L. B.) Mucous patches 
in the larynx do not appear to have the same ten- 
dency to spread as when situated on the soft palate 
and pharynx. If there is any indication for local 
treatment it should be by cauterization in the same 
manner as for lesion when located elsewhere. (Bos.) 

Cleansing Sprays of Dobell's Solution or Boric 
Acid are of the first importance ; these should gener- 
ally be made daily. 

Iodine, grs. v, to glycerine or fluid cosmoline, 3i, 



526 DIGEST OF EXTERNAL THERAPEUTICS. 

or Zinc Chloride in the same proportion ; the iodine 
is useful when there is increase of tissue, erosion and 
ulcerations, otherwise the chloride is better. When 
ulceration is deep increase the iodine to 15 grs. 

Guaiac: — gtt. j— ^i, as a spray or vapor for ulcera- 
tion and oedema. (Iv.) 

Europhen and Iodoform: — Are excellent applica- 
tions for superficial ulcerations. (Bos.) 

Calomel: — By insufflation, for ulceration. (F.) 

Carbolic Acid: — Grs. xx-xl-Oj, as an inhalant to 
correct fetor. (Al.) 

Nitrate of Silver: — gi— §i, for superficial ulceration. 
(Bos.) As a spray, grs. v— xxx-gi. (CI.) 

Mercuric Bichloride:— Solutions of 1-1000-500, as 
a spray are employed in all forms of deep ulceration 
and gummata. (Bos.) 

Chromic Acid: — Grs. x— gi. (Ba.) 

Galvano-Cantery: — Is the best means for arresting 
ulceration of the epiglottis. (L. B.) When a thick 
secretion coats the ulcer it should be removed with 
a cotton covered probe. 

SYPHILIS OF THE NOSE AND NASO-PHARYNX : 

Cleanliness is one of the most important features 
of treatment. Each time the patient is seen the nose 
should be thoroughly cleansed with cotton pledgets 
under illumination and at home by the patient with 
the douche two or three times daily. If the secretions 
are dry and hard, spraying the nasal chambers with 
warm liquid, vaseline before employing the cleansing 
wash will facilitate removal of hardened mass. 

The f ollowing are suitable for cleansing purposes : 





SYPHILIS. 




Sod. Bicarb., 








Sod. Biborat., 






aa gi. 


Acid. Carbolic 


( Calvert's 


No. i.), 


9i- 


Aq. Calidse, 






gxx. 


Ft. Sol. 








Potass. Chlorat. 


> 




5ss. 


Sod. Bicarbonat 


• j 






Sod. Biborat., 






aa 5i 


Aq. Calidse, 






S xx - 


Ft. Sol. 









527 



(Bn.) 

Sod. Bicarb., Sod. Biborat., Sod. Chlorid., equal 
parts; of this about 10 grains to water, 1 ounce. For 
cleansing in mild forms of specific co^za : Sod. Sali- 
cylate. (1 per cent.), Acid Salicylate (2 per cent.), 
Carbolic Acid (1-2 per cent.) are solutions useful 
when there is much discharge with tendenc} r to de- 
composition and dessication. These may be used in 
the nasal douche when there is ample room for escape ; 
otherwise the nasal bath may be preferred. 

Aqua Picis : — An excellent wash for frequent use. It 
is a good deodorizer and does not disorder the stom- 
ach as salkrylic acid and salicylate of soda may do. 
(T. 97.) 

Hydrogen Peroxide: — Forms a valuable applica- 
tion ; it both cleanses and deodorizes in a marked de- 
gree (Marchand, 15 Vol.); 1 part to 8 of water. (Bn.) 

After cleansing, a stronger detergent may be used, 
such as the following: 

Aluminum Aceto-Tartrate, 1—2 drachms of a 50 
per cent, solution to a pint of water, especially when 
there is ulceration and fetor. (T. 97.) 

Liq. Potass. Permang., 1-4 drachms to 20 ounces 
of water. 

Zinc. Sulpho-Carbolate, grs. xl, to water, 20 
ounces. 



528 DIGEST OF EXTERNAL THERAPEUTICS. 

The following formula combines solvent, stimulat- 
ing and powerful disinfecting qualities : 

Potass. Chlorat., 

Amnion. Muriat., aa 9i. 

Potass. Permang., £)ss. 

Aq. Calidse, gxx. (Bn.) 

Nitrate of Silver:— Grs. v-x-3, painted on (Bn.), or 
the fused drug, will cause large ulcers to heal. (Ing.) 

Chromic Acid: — 5 per cent, solution, painted on ul- 
cers for stimulation and healthy reaction in the sec- 
ondary form. (Bn.) 

Boric Acid: — 1 part, with 2 of Iodol or Iodoform, 
Aristol, Iodoform and Europhen for deep ulcera- 
tion after the sprays. Fine Powdered Camphor as 
a deodorant. Accumulated debris adhering to the 
edge of ulcerations should be removed with forceps. 
The curette may be employed for necrotic tissue when 
necessary. All sequestra should be removed, but it is 
advisable to wait until separation has occurred. 
(Bos.) 

Galvano- Cautery: — May sometimes be useful in re- 
ducing indurations. (Ing.) 

In Hereditary Syphilis of the Nose the local treat- 
ment should mainly consist of cleansing and disin- 
fecting lotions, as, for example : 

Sodii Bicarb., grs. iii. 

Acid. Carbolic (Calvert's No. i.), M. i. 

Glycerini, Opt., 3 1 - 

Aq. Destill., q. s. ad. §i. 

In applying solutions of this nature some writers 
advise the use of sprays alone, considering the 
syringe inexpedient. The latter, however, will be 
found effective if the infant is placed on the nurse's 
knee with the face downward and the nose then 
syringed out. 



SYPHILIS. 529 

Menthol: — 1 part, Olive Oil 9 parts, applied with 
a camel's hair brush, is useful for temporarily reliev- 
ing erectile swelling. 

Cocaine Hydrochlorate: — If the parts are much 
swollen and sensitive a few drops of a 4 per cent, so- 
lution may be applied before using the syringe. 

The following are useful ointments to be applied 
to the nostrils : 



Or, 



Calomelenos, ^i. 

Ung. Cetacei, %i. 



Aristol, grs. x. 

Lanoline, 

Vaseline, aa ^ss. (Bn.) 



SYPHILIDES: 

Local treatment will be required "when the lesions 
are situated on hands or face, and when it is desira- 
ble to hasten their disappearance on account of pro- 
fuse and disagreeable discharges. 

Before the application of the proper medication, 
all crusts should be removed by warm antiseptic so- 
lutions. 

Ung. Hydrarg. Inunctions: — Are used in various 
syphilides with the best results. 

Calomel and Traumaticin: — A bath is first given, 
then a 25 per cent, mixture of calomel in traumaticin 
is painted on where there are any syphilitic manifes- 
tations. The results are said to be very favorable in 
syphilides of the papular, pustular and squamous 
varieties, and in small circumscribed lesions. (CI.) 

Hydrarg. Oleate: — 20 per cent, ointment for dry le- 
sions. 

35 



530 DIGEST OF EXTERNAL THERAPEUTICS. 

For erythematous forms : 



Resorcin, 5ss. 

Adipis, 5i. (B. H.) 



Or, 



Hydrarg. Chloridi. Mitis, 

Pulv. Amyli, aa gi. 

Hydrarg. Chloridi. Mitis, £i. 

Ung. Zinc. Oxid., 

Ung. Petrolei, aa gss. (W. M.) 

For papular forms : 

Hydrarg. Praecipitat. Alb., ^i. 

Amyli, 

Zinc. Oxidi, aa 3 ii. 

Vaselini, ad. Ji. (B. H.) 



Or, 



Ung. Hydrarg. Ammoniat., Qi. 

Ung. Aq. Rosae, ^i. (W. M.) 

Hydrarg. Chloridi. Mitis, 

Ung Petrolei, aa gss. (W. M.) 



For pustular forms : — Hot Vapor Baths, followed 
by one of these ointments : 

Hydrarg. Bichlorid., gr. i. 

Ung. Hydrarg. Nitrat., 

Ung. Petrolei., aa gss. 

Ung. Zinc. Oxidi, 3 V1 - 

Hydrarg. Oxidi Rub., 5^- 

Alkaline Baths: — Are indicated in scaly lesions, 
particularly those of the palms> which are difficult 
to cure. (B. H.) 

Labarraque's Solution: — Added to wet dressing, is 
of service in macerating hard crusts. (Al.) 

Liq. Potassa: — Pure or diluted, used on hard in- 
durated lesions. (B. H.) 



SYPHILIS. 531 

The following are also for lesions of a hard scaly 
character : 



Ung. Hydrarg., 




Amyli, 




Zinc. Oxidi, 




Vaselini, 


Equal parts. 


Hydrarg. Chloridi. Mitis, 


grs. xx. 


Zinc. Oxidi, 


Si- 


Amyli, 


5ii- 


Vaselini, 


ad. gi. (B, H 



Dusting powders are of benefit, namely : Aristol, 
Europhen, Europhen-Aristol, Dermatol, Calomel, 
Iodoform, Lycopodium, and Bismuth Subnitrate. 
(Cl.) 

Ung. Diachylon: — When a soothing application is 
necessary. 

Mercurial Plasters:--Have excellent effect on thick- 
ened epidermis and gummata. 

SYPHILITIC ULCERS (Compare Ulcers): 

Aristol: — Has a remarkable influence on ulcers of 
this variety, and is regarded as superior to any other 
agent. (Sm.) 

Iodoform: — Has been freely used in various forms, 
but is generally disappointing for open ulcerations. 
(Al.) 

Hydrarg. Oxid. Rub.: — Equal parts with starch 
forms an excellent dressing when granulations are 
indolent (AL), or the officinal ointment diluted in the 
proportion of 1 part to 8 or 10 of sulphur ointment. 

(N. ) 

Hydrarg. Salicylate: — A lotion of 5 grains of the 
salt, with 5 grains of carbonate of potash, to the 
ounce of distilled water, or an ointment of 16 grains 
to the ounce. (Al.) 



532 DIGEST OF EXTERNAL THERAPEUTICS. 

Hydrarg. Sozoiodate: — An ointment of 2-10 pe r 
cent, or dusting powders of the same strength with 
talc or starch . ( F . ) 

Lotio Flava: — A strong stimulant and detergent to 
foul ulcers. (Al.) 

Naphthalim — The following combination with cal- 
omel is advantageously applied : 

For inflamed ulcers : 



(Sm.) 



Hydrarg. Chloridi. Mitis, 

Naphtholini, 

Ung. Camphorae, 


grs. x. 

3vii. 


Emplast. Plumbi, 
Ung. Hydrarg., 
01. Cadini, 


^ii. 

3ss. 

3 a. 


phagedenic ulcerations : 




Acid. Pyrogallic, 
Vaselini, 


i part. 
5 parts 


Acid. Pyrogallic, 
Amyli, 


i part. 
3 parts. 



;b. t.) 



Or, 



(N.) 

For very chronic ulcers energetic treatment is re- 
quired; the Cautery, Acid Nitrate of Mercury, 
Chromic Acid or Zinc Chloride (the last preferable) 
are indicated. Applications should be preceded by 
cocaine. 

The following ointment is also useful for very 
chronic types : 

Acid. Tannic, grs. lxxv. 

Hydrarg. Nit. Acid., gtts. xii. 

Adipis, 3 vnss - (Sn.) 



TATTOO MARKS. 533 



TATTOO MARKS. 

Dr. Variot, of Paris, claims to successfully remove 
tattoo marks in the following manner: A concen- 
trated solution of Tannin is applied to the skin, and 
worked in the same way as in the tattoo operation. 
The skin is then rubbed with a crayon or a solution 
of Nitrate of Silver, which is allowed to remain on 
until the tattoo marks stand out as black points on 
the tannate of silver. Any excess of fluid should be 
wiped off. The surface turns black and moderate in- 
flammation ensues ; after fourteen or fifteen days the 
eschar drops off, leaving a red superficial cicatrix, 
which after about two months will disappear. (Sh.) 



TETANUS. 

The wound should receive the most energetic Anti- 
sepsis. Lugal's Solution may be applied in addition. 
(A.) 

Antitoxine: — Recent writers claim that this treat- 
ment has reduced the death rate from 80 per cent, to 
37.37 per cent. (A.) 

Roux and Vaillard recommend the following : The 
wound is first excised, then giii ^iii (100 c. c.) of the 
active serum is injected ; the injection is repeated the 
next and the following day, and continued daily as 
long as symptoms last. The serum, while it neutral- 
izes the poison in the blood, does not act upon the 
germs at the wound, so, unless the source of infection 
can be removed, the disease may return. It is ad- 



534 DIGEST OF EXTERNAL THERAPEUTICS. 

visable, therefore, to keep up the injection for ten to 
twelve days after the disappearance of symptoms in 
order to guard against recurrence. (F.) 

Behring's Antitoxin is undoubtedly effective in 
the treatment of traumatic tetanus, and should be 
administered in all forms. The following summa- 
rizes a recent opinion in regard to this method : 1. It 
is best to give it as early as possible. 2. The local 
treatment, which consists in a complete destruction 
as soon as possible of the primary lesion, must not 
be omitted, for it might tend to a constant supply of 
toxine. 3. The symptomatic treatment with seda- 
tive drugs must be pursued in conjunction with 
serum therapy, as it may be effective when the lat- 
ter fails. 4. Old methods for eliminating the poison 
from the body must not be neglected. 5. The pre- 
ventive treatment leaves much for further investi- 
gation. (J. M. C, 4, 16, 96.) 

Hydrarg. Bichlorid.: — (Celli's Treatment.) The hy- 
podermic injection of this drug has been attended 
with success. A case is reported in which, after the 
failure of other remedies, injection into the buttocks 
of T |~o grain twice daily resulted successfully. After 
the second dose the convulsions decreased in frequen- 
cy and severity, and after the seventh ceased en- 
tirely. (F.) 

Carbolic Acid: — By hypodermic injection (Baccelli's 
method), has been used successfully, though the exact 
status of the treatment remains uncertain, success 
has been reported from doses of -^ grains of the 
acid every two hours (F.), and apparently hopeless 
cases recovered after the administration of 12 drops 
of a 2 per cent, solution injected every three hours. 
(Sj.) 



TRACHOMA. 535 

Morphia: — Injections in the tetanized muscles give 
relief. (B.) 

Ether Spray: — Apply to vertebral column, from 
three to five minutes every three-quarters of an hour, 
first along the spine, and later over the affected parts. 

(Sj.) 

Ice and Cold Water: — Continuous application, or 
irrigation to the affected parts immediately after re- 
ceiving the wound maintained night and day for one 
week, is recommended. (Sj.) 

Hot Baths: — In conjunction with other measures 
are sometimes useful adjuvants. (T. 96.) 

Amyl Nitrate Inhalations and Anaesthesia: — For 
temporary relief . (B.) 

Curare: — Should be useful for its effect upon the 
terminal nerves, but as yet experience does not con- 
firm it. Dose, 2V gr., hypodermically, cautiously in- 
creased. The strength of the drug may vary. (Ty.) 

Saline Infusions: — Intravenous or subcutaneous, 
are valuable agents. (F.) 

Rest: — A most important therapeutic measure. 
This must be literally absolute m the strictest sense of 
the word ; every sound should be excluded, the room 
darkened, the ears plugged with cotton, drafts of air 
excluded, and the attendance must be so conducted 
as not to cause the slightest noise. (Gn.) 



TRACHOMA. 

This disease exists in so many varying degrees of 
severity, and the classification of its types, according 
to different writers, presents such a divergence, "that a 
concise summary of the plans of treatment is difficult. 



536 DIGEST OF EXTERNAL THERAPEUTICS. 

For those cases attended with intense photophobia, 
lachrymation, vascular keratitis, and even iritic dis- 
ease, which appear in all grades of severity, the fol- 
lowing preliminary treatment is recommended by 
Roosa: 

Hot Water: — This should be employed as a fomen- 
tation, using absorbent cotton dipped in boiling wa- 
ter, applied continuously to the eyes for twenty min- 
utes about six times a day. 

Sulphate of Atropia: — Instillations three to six 
times a day of a solution of the strength of 2 grains 
to the ounce. 

Scopolamine Hydrobromate: — Instillations of a so- 
lution, 1 gr. to the oz., may be substituted for atro- 
pine, if desired. 

Cocaine Hydrochlorate: — If this is successful in re- 
lieving the photophobia it may be repeated, using 
considerable quantities from four to six times a day ; 
the solution should contain 8 grains to the ounce. 
These measures, if successful, will lessen the photo- 
phobia and lachrymation, and prepare the eyes for 
the use of astringents, of which Tannic Acid, in the 
form of a spray, or Alum Crystals, applied once or 
twice a day, are recommended as the best with which 
to begin. (Ro.) 

Sulphate of Copper: — If the disease gradually yields 
to the above line of treatment this remedy, in the form 
of the crayon or crystals, may be applied once or 
twice a day, and the result in a few weeks, even in 
the most obstinate cases, will be satisfactory. (Ro.) 
Sulphate of copper is generally regarded as one of the 
best preparations for ordinary forms in which there 
is little, if any, purulent discharge, and where there 
is considerable thickening of the conjunctivas. The 



TRACHOMA. 537 

effect can easily be regulated from a slight to an al- 
most caustic action according to the heaviness of the 
touch. Applications should be repeated from every 
other day to once or twice a week ; every part of the 
conjunctivas within reach should be touched, includ- 
ing the retrotarsal folds. (N. 0.) 

The following antiseptic lotions applied to the 
everted eyelids are recommended : 

Hydrarg, Bichlorid., 1-1000. 

Carbolic Acid, grs. vi, Glycerine, gi. 

Formalin, 1-1000-2000. (Bl.) 

Tannic Acid : — Solutions in glycerine from 10 
grains to the ounce up to a saturated solution are 
very effective. In chronic intractable cases they may 
be used twice a day, a drop in the conjunctival sac. 
(Ro). 

A solution of 15 grs. to the oz. is also recommended 
for painting on the everted eyelid. (Bl.) 

Nitrate of Silver: — The crayon should never be used 
under any circumstances ; the mitigated crayon 
(equal parts of nitrate of silver and nitrate of pot- 
ash) and the solution, grs. v— x-^i, should be limited, 
if used at all, to cases where there is marked purulent 
secretion. (N. O.) 

Ichthyol: — Is said to have excellent effect, viz: 

Ichthyol., 5 parts. 

Distilled Water, 4 parts. 

Glycerine, i part. 

The everted eyelids are painted with the mixture, which is per- 
mitted to remain on from sixty to ninety seconds, then washed off 
with water. It is indicated at every stage. In children a 30 per 
cent, solution may be used. (T. 98.) 

Jequirity: — Burnett says this remedy is now very 
little used because of its danger to the cornea, which 
is liable to become ulcerated unless the pannus is 



538 DIGEST OF EXTERNAL THERAPEUTICS. 

very dense. Roosa, however, says he has used it a 
great deal, and in no case was there damage to the 
cornea. The same writer recommends that the rem- 
edy first be converted into a powder. The patient is 
under the care of an attendant, and the powdered 
drug, to the amount of a grain, is applied to the 
palpebral conjunctiva. In most cases there is re- 
action, consisting of pain in the lids, redness and 
oedema; for this ice cloths may be applied. A mem- 
branous deposit in most cases will be formed upon the 
conjunctiva in about four hours ; further use of the 
drug must then be stopped. In obstinate cases it is 
necessary to repeat the application once, twice, and 
occasionally even three or four times. When the in- 
flammation produced by the application is over the 
cornea wall be less vascular, the photophobia de- 
creased and the condition such as to call for the use 
of astringents, which should finish the treatment. 

Sulphate of copper is especially indicated at this 
period. The care of an attendant is necessary for 
the safe application of jequirity. (Ro.) 

The more recent surgical measures for chronic cases 
are the f ollowing : 

Expression: — Of the operative methods this is pre- 
ferable. It consists of squeezing out the morbid tis- 
sues. The patient must be anaesthetized, the lids 
everted, and the loose rolls of the conjunctiva seized 
with the forceps, and stripped of the contents by a 
slow movement. This is continued until all tracho- 
matous granules have disappeared. The conjunctiva 
is then washed with boric acid ; the eyes are left 
open afterward. In a few days astringents may be 
applied. The conjunctiva is congested for sometime, 
but this gradually disappears and recovery occurs 



TRACHOMA. 539 

with little morbid tissue remaining and but little con- 
traction. (Ro.) 

Grattage: — After anaesthesia the lids are everted, 
the fornix exposed, and put on the stretch over the 
blade of the forceps. The conjunctiva is scarified by 
making incisions close together, parallel to the mar- 
gins of the lids. These incisions are united by others 
running transversely, the depth of the incisions de- 
pending upon that of the trachomatous tissue ; they 
generally pass through it. The surface is then 
scraped thoroughly with a tooth brush, having 
short stiff bristles, dipped in a solution of bichloride 
of mercury, 1-500. The eye is then washed and 
bandaged with an antiseptic dressing. The rubbing 
is repeated every day after the operation for two 
weeks, this frequently depending upon the amount of 
reaction. CBdema of the lids will follow, but it is 
claimed by those who endorse the procedure that the 
reaction is generally slight. The operation does not 
meet with general approval. (Ro.) 

Galvano-Cautery: — This is another method used 
for touching the trachomatous granules, but it is in- 
ferior to the method of expression when properly 
executed. Its use is best adapted to discreet forms 
with little engorgement. (N. O.) 

Proper hygienic surroundings are of much impor- 
tance. Overcrowding, smoke, dust, and bad atmos- 
phere of any kind should be avoided. High altitudes 
exercise a favorable influence on the disease, as it is 
likely to do in all forms of dyscrasia. Outdoor exer- 
cises or work are beneficial, provided it is not amid 
dirt, dust or smoke, or in stables or at farm work. 
(N.O.) 



540 DIGEST OF EXTERNAL THERAPEUTICS. 



TOOTHACHE. 

Dry Heat:— This much used, and often effective pal- 
liative, may be applied to the face in the form of the 
hot water bag or a bag filled with hot hop flowers. 
A poultice should never be used. The following rem- 
edies are to be applied by saturating a small piece of 
cotton, inserting it in the cavity of the carious tooth 
and coating with collodion: 

Alum: — A solution in nitrous ether, 3i-3vii, is said 
to be very effective. 

Tannic Acid: — Druitt's formula for toothache, viz 

Tannic Acid, J}i. 

Mastich., grs. x. 

Ether, ^ss. (B.) 

Chloroform and Camphor: — A mixture of these two 
agents forms one of the best applications. (N.) 

Essential Oils: — Creosote, commonly used ; Cloves, 
Cajuput, Chaulmoogra, Origanum, Peppermint, 
Sabina, and Thyme. 

Cocaine Hydrochlorate: — May afford relief, but is 
apt to aggravate the condition upon which the pain 
depends. 

Atropine: — 1 per cent, solution. 

Aconite: — A few drops of the tincture. 

Chloral and Camphor: — Equal parts. (F.) 

Capsicum : — A few drops of the tincture or fluid 
extract is sometimes used. (N.) 

Odontine: — A name applied to various preparations 
for the teeth. English odontine is as follows : 

Camphor, 5 parts. 

Alcohol, io parts. 

Chloroform, 20 parts. 



TOOTHACHE. 541 

Another formula : 

Oil of Cajuput, 2 parts. 

Oil of Cloves, 

Oil of Juniper, each 3 parts. 

Ether, 24 parts. 

A bit of cotton is saturated with the above and inserted into cav_ 
ity. (F.) 

Odontol: — A new preparation; formula as follows: 

Cocaine Hydrochlorate, 

Oil of Cherry Eaurel, each 15 grains. 

Tr. Arnica, T50 grains. 

Solution of Amnion. Acetat., 300 grains. 

If the pain is caused by caries, a piece of cotton saturated with 
this solution should be inserted; if by inflammation of the pulp, 
the mouth should be washed with Odontol diluted with twice its 
bulk of warm linseed tea; if the pain extends to the entire jaw, the 
part should be rubbed with the preparation. Caution should be 
observed lest any portion is swallowed. (F. ) 

Carbolic Acid and Collodion: — These agents are 
fused by melting crystals of the acid in a test tube and 
adding equal parts of collodion ; the mixture is a 
jelly. When first inserted into the tooth there will 
be an aggravation of pain, followed by relief. (B.) 

Piscedia: — The most reliable preparation is the 
fluid extract ; it may be used with much benefit. (F.) 

Phenoresorcin: — The powder placed in the cavity 
will afford relief. (B.) 

Tr. Aconite and Tr. Iodine: — Equal parts, with or 
without a small quantity of Chloroform, painted on 
gums is effective ; in some instances the iodine alone 
is used. (F.) 

Carbonate of Soda: — A saturated solution held in 
mouth relieves. (B.) 

Chloroform Water: — May be used as a mouthwash 
for toothache. (N.) 

Chamomile: — The flowers steeped in hot water and 



542 DIGEST OF EXTERNAL THERAPEUTICS. 

inserted into a small lace bag and applied to the gums 
over ulcerating tooth will sometimes afford relief. 

Pyrethrum: — The tincture is employed by dentists 
to relieve toothache and as an ingredient of mouth 
washes. 



TONGUE, FISSURE OF. 

Nitrate of Silver: — The crayon; useful when the 
lesion is superficial. (Bt.) 

Borax: — With honey or glycerine, a popular rem- 
edy, 40 grains, with glycerine 1 ounce, and water 4 
ounces. (N.) 

Hydrastis: — A valuable drug; about 5-10 drops to 
2 ounces of water for a mouth wash. (R.) 

Nitric Acid: — 5 drops, water 3 ounces, or Carbolic 
Acid, same strength, are both recommended for 
mouth washes. (Rd.) 



TONGUE, ULCERS OF. 

For ordinary simple acute ulceration the treatment 
mentioned under Stomatitis and Aphthae will suffice. 
For syphilitic ulcerations, as far as external remedies 
go, the same will answer, proper internal medication 
being all important. 

Lactic Acid: — Applications of a 50 per cent, solu- 
tion made every other day, gradually increasing 
strength, are of service in tubercular ulcerations. 

Chronic ulcerations should be removed by surgical 
means. (F.) 



TONSILS, HYPERTROPHY OF. 543 



TONSILS, HYPERTROPHY OF. 

Enlarged tonsils, in which the hypertrophy is of 
long standing, and the tissues are dense and firm, 
will not yield to any form of treatment, and should 
be excised at once. There are many cases, however, 
in which the tissues are less dense and firm and the 
condition not so chronic, where remedies will pro- 
duce results. 

Astringents: — Are both extensively recommended 
and condemned as of doubtful efficacy; their action, 
it is claimed, being limited to the reduction of inflam- 
mation, with no influence upon the hypertrophied 
tissues. 

The following are among the best : 

Glycerole of Tannin. 

Nitrate of Silver, grs. iij— v— ^i. 

Sulphate of Zinc, grs. v— x— gi. 

Sulphate of Copper, grs. iij-^i. 

Alum by Insufflation. (Bos.) 

Infusion of Catachu. (F.) 

Ammon. Iodide.: — ^ss, with glycerine ^i, painted on 
at night, has proved effective. (Wa.) 

Iodine: — A few drops injected into the gland has 
been used, but the procedure is open to objection. 
(Bos.) 

Trichloracetic Acid: — Has been found useful, em- 
ployed in the following solution: 

Trichloracetic Acid, grs. v. 

Sodium, grs. ii. 

Potass. Iodide, grs. ijss. 

Glycerine, gi. (F.) 

Tonsillotomy: — This is the one measure of relief 



544 DIGEST OF EXTERNAL THERAPEUTICS. 

which should be advocated in all cases unless there 
are special reasons counter-indicating it. The gland 
may be best removed by the tonsillitome, galvano- 
cautery, ecraseur, or cold wire snare. In a large ma- 
jority of cases the tonsillitome is the best instru- 
ment. The galvano-ecraseur possesses the advan- 
tage of extirpating without haemorrhage; it is, how- 
ever, slow and difficult to manipulate with children 
unless an anaesthetic is administered. In adults it 
may be used to advantage in order to avoid haemor- 
rhage, which should always be anticipated. (Bos.) 
In using this instrument the wire should not be al- 
lowed to go too deeply or to destroy tissue beyond 
the incision. 

Cold Wire Snare- — When the tonsil is flat and 
deeply imbedded between the pillars of the fauces and 
it is impossible to reach it with a tonsillitome this 
can be used with advantage. (Bos.) The haemor- 
rhage after tonsillotomy is usually slight; it is advis- 
able, however, to allow the patient to hold cold wa- 
ter in the mouth, in which a little Gallic or Tannic 
Acid has been dissolved. If haemorrhage persists, 
saturated solutions of these remedies may be applied. 
If styptics are required, which is rarely the case, ap- 
ply a saturated solution of Chromic Acid. 

In all operations it is important to avoid wound- 
ing the pillars of the fauces, lest haemorrhage occur, 
and loss of control of the muscles result. (Iv.) 

Suprarenal Extract: — For the use of this agent in 
controlling haemorrhage during operations on the 
nose and throat see Adenoid Growths of th,e 
Pharynx. 

Galvano-Cautery: — Of the local destructive agents 
used for the removal of the tonsils, this may be 



TONSIL, HYPERTROPHY OF THE LINGUAE. 545 

regarded as the most satisfactory. It is, however, 
a slow process. A slender pointed electrode should be 
selected and a number of punctures made with 
it in the face of the hypertrophied gland . This is 
better than superficial burning. Ivins recommends 
the galvano-cautery for hypertrophied tonsils with 
large open crypts. , The point of the needle should 
be thrust into the opening of the crypt while 
the current is turned on and removed while hot 
in order to avoid unnecessary pain. Two or three 
lacunae are thus treated at a time. Cocaine may be 
first applied. The reaction is slight and the treat- 
ment may be repeated in five days. This method is 
usually the most satisfactory for treating lacunar 
tonsillitis. If there are bands of tissue which prevent 
the free exit of caseous masses they should be divided 
or torn with a probe and the cavities emptied. (Iv.) 
Mineral Caustics: — These are slow, unsatisfactory 
and require great caution in application, else neigh- 
boring tissues are destroyed ; their use is not gener- 
ally commended. Chromic Acid is the best of these 
agents, and continues to be advocated by some 
authorities. The fused acid on the point of a probe 
may be used on enlarged glands with open and dis- 
tended crypts. (Iv.) 



TONSIL, HYPERTROPHY OF THE 

LINGUAL. 

The general indications are correction of the irri- 
tant character of the buccal secretions and the re- 
moval of the growth (L. B) 

36 



546 DIGEST OF EXTERNAL THERAPEUTICS. 

Iodine: — The glycerole painted on. (Ba.) 

Chromic Acid: — This agent is condemned by Len- 
nox Browne as dangerous. Its use, however, is al- 
lowed by other writers (P. M.), especially with the 
mirror, and under full illumination, when pain and 
danger are minimized. The fused acid on a probe 
after cauterization is employed. (T. 97.) 

Gal vano- Cautery: — This is undoubtedly the best 
agent for the removal of redundant tissues ; the por- 
celain point or caustic snare may be used. (L. B.) 

Cold Wire Snare: — Suitable for the removal of 
large, prominent masses. (P. M.) 



TONSILLITIS. 

ACUTE FOLLICULAR TONSILLITIS: 

Importance of local treatment is now recognized ; 
mild antiseptic sprays and gargles should be em- 
ployed. (T. 98.) 

Hydrogen Peroxide: — 1 part to 8 of water does 
efficient service. (F.) 

Creosote: — As a gargle, 1—2 drops to the ounce of 
water. (T. 98.) 

Salol: — 5 per cent., alcoholic solution 1 drachm, 
to 2 ounces of lukewarm water. 

Izal: — 1-200, as spray is said to tend to shorten 
attack. (T. 96.) 

Iron Sulphate (Monsel's Sol.): — Applied undiluted 
to the seat of inflammation will quickly constringe 
the inflamed tissues, and promote recovery. Apply 
twice daily. (F.) 

Potass. Chlorate: — Solutions may be used as a 
gargle in the intervals of application of Monsel's so- 



TONSILLITIS. 547 

lution (F.) Solutions of 31-^iY, generally, as a gar- 
gle. (P. M.) 

Simple gargles of Boric Acid, Borax, Phytolacca 
and Boroglyceride (1-5). 

ACUTE SUPPURATIVE TONSILLITIS (Quinsy): 

Ice: — Constantly holding small bits of ice in the 
mouth during the onset of the disease is often useful 
for allaying heat and pain. 

Sod. Bicarb.: — The patient should be provided 
with a saucer of bicarbonate of soda, and every half 
hour, by simply wetting the forefinger, he can smear 
the inflamed fauces with the remedy. This simple 
procedure is highly recommended for relieving the 
pain. (Bos.) 

A saturated solution is also used as a gargle for re- 
lief of the accumulation of ropy mucus. 

Hot Compresses: — Flannels wrung out in hot wa- 
ter and laid over region of tonsils is soothing to some 
patients. 

Tr. Guaiacum:— 1 drachm, to hot water 1 ounce, 
held in the mouth may be comforting in the early 
stages of the disease. (Iv.) 

Nitrate of Silver: — 31-gi, painted on once or twice 
a day may be said to be successful in 1 case in 4 ; two 
or three applications usually necessary. (Ing.) 

Steam Inhalations: — In early stages, lasting five to 
ten minutes. A little eucalyptol may be added. (Iv.) 

Hot Water Gargles: — Useful in second stage. (Ba.) 

Incision: — As soon as presence of pus is ascertained, 
incision should be made, followed by hot gargles for 
facilitating escape of pus. In some cases it is desira- 
ble to pass a director into the opening to prevent too 
early closure. (Ba.) 



548 DIGEST OF EXTERNAL THERAPEUTICS. 

After recovery when the glands remain large they 
may be painted with the following : 

Iodi, grs. vi. 

Potass. Iodid., grs. x. 

Ol. Menth. Pip., M. v. 

Glycerini, ad. ^i. (P. M.) 



TORTICOLLIS OR STIFF NECK. 

(See Muscular Rheumatism.) 

TRICHOPHYTOSIS. 

TRICHOPHYTOSIS BARBM: 

Treatment must be governed by the duration of the 
disease and the condition of the hair follicles, whether 
they are involved, or the affection is mainly superfi- 
cial ; also by the extent of inflammation. 

It is a matter of the utmost importance that the 
disease be prevented from invading the follicles. This 
may be accomplished as follows : The beard on the 
affected part should be clipped close with a pair of 
curved scissors, not shaved, lest the disease be spread. 
Scales or crusts, if present, should be removed by 
washing with warm water and Potash Soap thor. 
oughly applied, and the loose hairs pulled out, after 
which an alcoholic solution of Boric Acid, gi-^i, or 
Corrosive Sublimate, 1-400-500, or Carbolic Acid, 
3i-^iv, should be used on the hairy part of the face. 
After drying thoroughly a strong parasiticide should 
be applied. (B. H.) 

While the remedies for trichophytosis capitis are 



TRICHOPHYTOSIS. 549 

generally applicable to this form of the disease, the 
following are worthy of especial mention : 

Chrysarobin: — An ointment of xxx— ^ss— 3i is em- 
ployed advantageously. The disadvantages attend- 
ing this drug must not, however, be forgotten. 
(Mor.) Dr. W. T. Corlett recommends a solution, 
in traumaticin or collodion, grs. xx-xxx— ^i, to be 
painted on when there are only two or three lesions. 
The coating should be removed daily, the hair clipped, 
and the varnish reapplied. 

Iodine: — When there is much irritability and there 
are several lesions, the tincture may be painted on as 
often as the condition of the skin permits. (Ck.) 

Hydrarg. Bichlorid.: — Very effective ; may be used 
as follows : 

Hydrarg. Bichlorid., grs. viij. 

Alcohol., gi. 

Hamamelidis Destill., giij. (Sh.) 

Sulphur: — The following combination is effective : 

Sulphur. Prsecipitati, gi. 

Acid. Carbolici, J}i. 

Vaselini, ^i. (Hd.) 

Apply twice daily. 

Copper Oleate: — This remedy occupies a prominent 
place in the treatment of this affection, viz : 



Or, 



Cupri Oleat., 3 SS - 

Lanolini Cum Oleo, §i. (Ck. ) 

Cupri Oleat., grs. v. 

Ol. Chamomillse, gtts. v. 

Ung. Oxidi Zinci, gi. (Sh). 



Hyposulphite of Soda: — 1 part to 8 of distilled wa- 
ter, mopped on the affected part three or four times 
daily, is useful. (Hd.) 



550 DIGEST OF EXTERNAL THERAPEUTICS. 

When the hair follicles are involved, the pathoge- 
netic changes are deep-seated, and the condition is 
similar to kerion. The indications for treatment 
under these circumstances may be briefly summarized 
as follows : 

1. Remove the crusts by soaking in oil, and after- 
wards washing with warm water and potash soap. 

2. Epilation, and shaving, daily or on alternate 
days. 

3. The application of penetrating parasiticides, 
such as the Oleate of Murcury (20 per cent.), 30 
grains, Sulphur 30 grains, with lanoline 3vj, oil of 
almonds 311, thoroughly rubbed on the skin 3 times 
daily ; or Oleate of Copper grs. x-xxx-^i, or Ichthyol 
3ss-3i. 

When there is much inflammation, Scarification, 
and the application of saturated Boric Acid lint 
Compresses is recommended. As the growth of the 
parasite is favored by moist heat, poultices are con- 
tra-indicated. (B. H.) 

TRICHOPHYTOSIS CAPITIS: 

This is one of the most obstinate forms of ring- 
worm. The hair should be cut short and the scalp 
scrubbed with soap and -water, using preferably tar 
soap ; the diseased hairs should be pulled out with 
forceps, and a parasiticide applied. In boys, when 
the eruption is extensive, the scalp may occasionally 
be shaved. During the course of the treatment it 
will be necessary to thoroughly free the scalp from 
the accumulation of epithelial scales, broken hairs 
and medicaments; for this purpose use German Green 
Soap, Soft Soap, or Tincture of Soap; afterwards 
the parts should be dried with alcohol or ether. 



TRICHOPHYTOSIS. 551 

As the fungus retains its vitality several years all 
the articles worn about the head and neck should be 
burned. Stringent prophylactic measures must be 
observed in regard to unaffected children who are ex- 
posed to the disease. The most scrupulous cleanli- 
ness must be enforced, and no healthy child be per- 
mitted to sleep with one who is affected or use the 
same brush, comb, towel, cap, or other article. Bad 
hygienic surroundings should also be corrected, such 
as damp or ill ventilated apartments. As a prophy- 
lactic measure it is advised to keep the hair cut short 
and apply an antiseptic wash, such as a Saturated 
Solution of Borax or Carbolized Oil. 

Epilation: — In acute or recent cases, when the fun- 
gus has not penetrated very deeply, the ordinary 
parasiticides are often successful without the neces- 
sity of epilation. In the cases commonly encountered, 
however, the disease has existed for some time, and 
this measure is essential. (Pp.) Crocker recommends 
a 10 per cent, solution of Cocaine in cosmoline, or 
Carbolic Acid in glycerine, 1-20. Bazin paints the 
parts with Oil of Cade, with a view of lessening the 
pain, removing about a quarter of an inch daily. 
Rigolene has also been used, but local anaesthesia is 
not very successful. 

Of the numerous drugs which have been extolled 
for use in this affection, the following are presented 
for consideration. It must be borne in mind, how- 
ever, that thoroughness and persistence in applica- 
tion are most essential if a successful result is to be 
attained : 

Oleate of Mercury: — Highly endorsed, especially 
in the diffuse form. A 5 per cent, ointment for chil- 
dren under 8 years, or a 10 per cent, for older chil- 



552 DIGEST OF EXTERNAL THERAPEUTICS. 

dren. A small piece is rubbed vigorously into the 
affected part night and morning; if there is much 
tenderness it may be omitted for a day or two. In 
the early stages, when there are only a few circum- 
scribed patches, a more powerful application will be 
required ; in this case a 10 per cent, ointment may be 
employed. (A. W.) Stronger preparations are rec- 
ommended, as 1 drachm of the 20 per cent, ointment 
to 1 ounce. This must be used with caution for fear 
of salivation. (B. H.) 

Ammonio-Chloride of Mercury: — 20 grains to 4 
drachms of sulphur ointment, is strongly recom- 
mended by Sir William Jenner. 

Chrysarobin: — Unna's method of treatment is as 
follows : 1. Cut the hair close over the whole scalp. 
2. Apply a protective zone of zinc paste, extending 
for a short distance over the smooth surface. 3. Then 
apply over entire scalp the f olio wing ointment: Chrys- 
arobin, 5-10, salicylic acid, 2 per cent., ichthyol, 5 per 
cent. 4. Cover this with some impermeable sub- 
stance, such as gutta percha or rubber. A flannel 
bandage or close cap is then applied. 5. Remove cap 
or bandage once in twenty-four hours, loosen dress- 
ing on one side, turn it over, and apply the ointment, 
then seal as before. 6. On the fourth day the chrys- 
arobin ointment is removed with pledgets of cotton, 
and an ichthyol ointment, 5 parts to 100, is ap- 
plied daily for three days. On the expiration of the 
first week all dressings, including the zinc paste, are 
removed and the scalp cleaned with oil and soap. 
The whole process is repeated for another week, and 
so on until cure is complete. This method is highly 
commended, but caution is necessary lest too active 
inflammatory disturbances are produced ; when such 



TRICHOPHYTOSIS. 553 

is the case, suspend the chrysarobin and cleanse thor- 
oughly with hot water and soap. (B. H.) 

Carbolic Acid: — One of the most effective remedies ; 
it is used in various strengths combined with glycer- 
ine, or the following, suggested by Alder Smith, which 
has given satisfactory results : 

Acid. Carbolic. (Cryst. ), 

Ung. Hydrarg. Nit., 

Ung. Sulphur., aa gss. 

The ingredients are mixed without heat. The ointment may be 
used for children over eleven years of age; under that age, increase 
the proportion of Sulphur to double the amount or even more. 
The patches should be rubbed twice a day and the entire scalp 
once. (Hy.) 

The following combination is said to have suc- 
ceeded when carbolic acid, bichloride of mercury and 
chrysarobin have been used for four months without 
controlling the disease : 

Acid. Carbolici, 

Ol. Petrolei, aa §ii. 

Tr. Iodi, giiss. 

Ol. Ricini, giiss. 

Ol. Rusci, (German), q. s. ad. Oj. 

Apply over entire scalp once daily for four successive days, 
wash off with green soap on fifth day. Then clip the hair close 
and wash again as before. (T. 98.) 

Copper Oleate: — About 31— %\, is said to have been 
efficient even in the most obstinate forms. (N.) 

Formalin (pure or diluted): — Gives very good re- 
sults, though its pungent odor is a drawback. 
(T.98.) 

Boric Acid: — Useful in the following : 

Acid. Borici, 5 s8 - 

Ether, gv. 

Alcohol., gxx. (Ja.) 



554 DIGEST OF EXTERNAL THERAPEUTICS. 

Thymol: — Sometimes it has proved of value, and 
may be combined as follows : 

Thymoli, 5 SS - 

Chloroformi, 3ij- 

01. Olivae, 3vj. (Pp.) 

Iodine: — The tincture is one of the best remedies in 
severe cases, painted on the parts twice a day. (F.) 

Coster's paste, consisting of Tr. Iodine 2 drachms, 
Oil of Cade 6 ounces, is useful in recent cases. Paint 
on with a brush. In a few days remove the black 
crusts which form, by washing with soap and wa- 
ter; then reapply the paste. (A. W.) 

A solution of 1—1000 of iodine in iodide of potash 
has been successfully employed in ringworm of the 
nails, the wet dressings being covered by gutta 
percha. (T. 97.) 

Salicylic Acid: — The following is effective: The 
head is shaved in the usual way for at least an inch 
beyond the margin of the patch, then salicylic acid 
in collodion, 10 grains to the ounce, is painted on, 
extending beyond the diseased skin. This is repeated 
for a week ; at the end of this period the layer of col- 
lodion is removed by lifting it with the blade of the 
forceps inserted beneath the margin ; the salicylic 
acid is then applied for a week, and the same process 
of removal adopted, and so on until the disease is 
eradicated. Among the advantages of this method 
is the prevention of the access of spores to other 
parts. A solution of 1 drachm to the ounce of dis- 
tilled water is also used. (B. H.) 

Nitrate of Silver: — Devergie is in favor of applying 
a strong solution, 3— six of distilled water. This is a 
popular remedy both for ringworm of the head and 
body. 



TRICHOPHYTOSIS. ODD 

Blistering: — In very chronic cases and in the dis- 
seminated variety this is sometimes necessary. For 
this purpose the following: 

Cantharides Collodion (Squibb's) or Hydrarg. Bi- 
chloride, 4 grains, with acetic acid, 1 ounce, ma3 r be 
used for producing vesication. These, however, are 
too strong for children under six years of age and for 
delicate or strumous persons. The crusts which 
form in a few days should be removed and mild 
soothing dressings applied, such as liquor detergens 
ointment. Croton Oil is also advocated, but if used 
at all it must be with caution and on limited areas, 
as it ma}- cause permanent baldness. 1 part to 
10 of olive oil is usually strong enough, but the 
strength ma}' be increased until a mild degree of pus- 
tulation is produced, when a poultice should be ap- 
plied and the loose hairs removed. (B. H.) 

Tar: — May be employed in the form of the officinal 
ointment or oil of cade, or combined with mercury 
and sulphur, as follows : 

Ung. Picis Liquidse, 

Ung. Hydrarg. Nitratis, aa 5ii- 

Ung. Sulphuris, 3i v - " (^P-) 

Liq. Carbonis Detergen., 5i~ii- 

Hydrarg. Ammoniat., grs. x. 

Lanolini Comp. Cum Oleo, t ^i. 

This forms an effective and an agreeable ointment 
suitable for very young children and persons with 
delicate skins. (B. H.) 

Sulphur: — The officinal, or Wilkinson's ointment, 
or the following combination, are effective : 

Sulphur. Praecip., Xi. 

Hydrarg. Ammon., 3 SS - 

Thymol., grs. x. 

Vaselini, 5i- 

Ung. Simp. ad. gi. (A. W.) 



556 DIGEST OF EXTERNAL THERAPEUTICS. 

Naphthol: — A 1 per cent, solution in alcohol is 
used, or the following, which is recommended by Ka- 
posi: 

Naphthol., 5 SS - 

Spts. Sap. Vir., %{. 

Alcohol, 3 XXV - 

Balsam Peru, ^i. 

Lotio. Sulphuris, 3 V - 
Apply twice daily for two or three days; then scrub with green 
soap. 

During the course of treatment a change of remedy 
will often prove beneficial. After the disease has been 
apparently cured it will be advisable to continue 
with some mild parasiticide application for a short 
time. 

TRICHOPHYTOSIS CORPORIS: 

In selecting a parasiticide, the age of the patient, 
as well as the severity and extent of the lesion, should 
be taken into consideration. It may be necessary 
to remove hairs if the patient is very hirsute. 
The scales must first be washed off with soap and 
warm water, then some slightly irritating and 
astringent, or some antiparasitic application, will in 
most cases readily effect a cure. (And.) 

For infants : Resorcin (grs. xv-xx to alcohol or 
vaseline ^i). (B. H.) For adults and older children an 
ointment of Oleate of Copper (grs. v—xx-gi, increased 
if necessary). (Sm.) Ammoniated Mercury (grs. 
xv-xl-gi). (Vn.) Ichthyol (grs. x-xxx-gi). (B. H.) 
Sulphate of Quinine (5 per cent.). (F.) Salicylic 
Acid (10-20 per cent, ointment) used daily in con- 
junction with weekly applications of a Bichloride 
lotion. (Ja.) 



TUBERCULOSIS. 557 

Hydrarg. Bichlorid. grs. ii-iv to the ounce of alco- 
hol or water, or a solution of 10 grains to the 
drachm, retained in situ for a few minutes only. 
(And.) Compound tincture of Benzoini. (Ja.) The 
latter may be painted on once a week. 

Carbolic Acid:— 3i-^i of glycerine. (B.) 

Chrysarobin: — Grs. x— xxx-^i, suspended in flexible 
collodion or traumaticin, is excellent, but should 
not be used in cases of infants or about the face. 
(B. H.) 

The f ollowing is efficient in obstinate forms located 
on the thighs and groins: 

Creosoti, M. xx. 

Ol. Cadini 

Sulphuris, aa gi. 

Potass. Bicarbonatis, 

Adipis, aa ^i. (Vn.) 

Should remedies of this class fail, blistering fluids 
may be applied: Smith's Emplastrum Cantharidis 
Liquidi is good ; also Acetum Cantharadis, pre- 
pared with glacial acetic acid. It should be painted 
on the eruption with a small brush. One application 
is usually sufficient ; but if not, repeat in a few days. 
There are numerous other remedies, such as Sulphur- 
ous Acid, Acetic Acid, Sodium Sulphide, etc., all of 
which will be found of service. To prevent relapse, 
or the spread of contagion, the clothing should be 
boiled, baked, or in some way disinfected. 



TUBERCULOSIS. 

TUBERCULOSIS OF THE LARYNX: 

The important indications of treatment are relief 
of the dysphagia, the dyspnoea, and the ulceration. 



558 DIGEST OF EXTERNAL THERAPEUTICS. 

Deep ulcers are most effectively and speedily treated 
by surgical means ; in rare cases cured ; in any case 
relieved. 

Local treatment should be preceded by cleansing 
sprays, such as Boric Acid, Borax or Salt, grs. x to 
the ounce. (Gn.) Thorough cleansing is also essen- 
tial in order to limit the irritating action of the spu- 
tum. 

Lactic Acid: — Now accepted by most observers as 
one of the best topical remedies. Even in the most 
unfavorable cases it will relieve dysphagia. The 
strength of the application may vary from 10 per 
cent, to the pure acid. It is advisable to begin with 
a weak solution, as the healthy mucous membrane, if 
involved in the application, may become highly irri- 
tated. When hardened infiltrations are present, cu- 
rettage or scarification should precede the application. 
The acid acts quickly on soft ulcerations and with 
especial rapidity on ulcerated surfaces. Applications 
should be made daily with a brush ; then every other 
day. Laryngeal spasm and a sense of burning may 
follow, but these conditions may be relieved by co- 
caine in 10-15 per cent, solutions. (Al.) 

Curettement: — This measure is analogous to exci- 
sion for the removal of the focus of infection ; followed 
by lactic acid applications, it has proved highly ben- 
eficial. 

Indications — 1. Primary disease without pulmon- 
ary infection. 

2. Cases with concomitant lung disease incipient 
or arrested before softening or hectic. 

3. Circumscribed ulcerations and infiltrations. 

4. Dense, hard swelling of arytenoid region, tuber- 
culous tumors, affections of epiglottis. 



TUBERCULOSIS. 559 

5. Advanced lung disease with distressing dysp- 
noea. 

Absolute rest after the operation must be enjoined, 
with daily application of lactic acid and pyoktanin 
1-2 per cent. Cicatrization is usual in from one to 
four weeks. (L. B.) 

Ichthyol: — Applied pure after curettement has suc- 
ceeded when the operation followed by lactic acid 
has failed. (Sj.) 

Guaiacol: — Affords great relief, applied pure after 
lactic acid applications following curettement. Also 
in form of a 20 per cent, spray. (T. 97.) 

Chromic Acid:— A 3 per cent, solution acts well in 
superficial ulcerations. (T. 96.) 

Lacto-Carbolized Glycerine: — The following is 
claimed to form a superior application: 

Lactic Acid, £>ss. 

Neutral Glycerine, 5 v. 

Carbolic Acid, M. xv. 

As tolerance increases, the strength of the two 
acids is also increased two to four times. (Sj.) 

Monochlorphenol: — 5 per cent, solution in light 
petroleum oils or glycerine, is palliative in action. 

Parachlorphenol: — Mixed with glycerine in various 
proportions forms a soothing application. Report of 
10 cures out of 26 cases. (Sj.) 

Airol:— By insufflation, superior to iodoform or 
aristol. (T. 98.) 

Balsam Peru: — As an inhalant, 10 parts to 5 of 
alcohol, 20—30 drops in a pint of boiling water. (Al.) 

Resorcin: — Daily application of an 80 per cent, so- 
lution for ulcerative stage. (Al.) 

Sedative Inhalants: — Of the following solutions, 1 
drachm to a pint of boiling water may be employed : 



560 DIGEST OF EXTERNAL THERAPEUTICS. 

Ext. Opii, grs. v-gi. 

T. Opii Camphoratae, 3i-^i. 

Ext. Belladonna, grs. iv— gi. 

Ext. Stramonii, grs. v-^i. 

Iodoform: — For constitutional effects this remedy 
may be administered by inunction as mentioned un- 
der pulmonary tuberculosis. As a local remedy it ex- 
erts a retarding influence upon the disease and is in- 
dicated at any stage, but appears to yield the best 
results in superficial ulcerations of the arytenoid 
masses. It is usually employed pure by insufflation. 
A small proportion of morphine may be added ad- 
vantageously. For an astringent sedative effect the 
following: 

Iodoformi, grs. vi. 

Bismuth. Subnit., 

Benzoin. Res., aa grs. xxx. (Ing. ) 

Pyoktanin: — Probes heated, dipped in the powder 
and rubbed on the ulcers promote cicatrization. (Al.) 

Creosote: — Inhalations or sprays of this remedy 
are generally contra-indicated when there is a ten- 
dency to haemorrhage and by high temperatures ; if 
used under these conditions caution must be ob- 
served. 

The f ollowing are convenient formulae : 

For inhalation : 



Creosoti, 


M. lxxx. 


Magn. Carb., 


grs. xxv-xl. 


Aquse, 


^i. 


A teaspoonful to a pint of water. 


(Ivefferts.) 


Or, 




Creosoti, 




Chloriformi, 




Alcoholi, partes equale. 




A few drops on a sponge. 





TUBERCULOSIS. 561 

For a spray : 

Creosoti, M. ij. 

Menthol?, grs. iv. 

Albolenei, ^j. 
Use with an atomizer several times a day. (F. ) 

Terebene: — 5—40 minims, to water 1 ounce, with 
about 20 grains of mag. carb.; a teaspoonful of the 
mixture to a pint of water. Inhale the vapor at a 
temperature of 140° for ten minutes night and morn- 
ing. (F.) 

Cocaine: — For the relief of pain and dysphagia. A 
simple 4 per cent, solution as a spray (Os.), or the 
following : 

hydrochlorate of Cocaine, grs. iv. 

Hydrochlorate of Morphine, grs. ij. 

Antipyrin, ^ss. 

Cherry Laurel Water (made by distilla- 
tion ) , 

Sterilized Water, aa ^ ij . 
From 2—4 teaspoonfuls by atomization every twenty-four hours. 

Hydrochlorate of Cocaine, grs. iij. 

Sugar of Milk, 

Gum Arabic, Powdered, aa. ^i. 

Apply by insufflation. (T. 97.) 

Formaldehyde: — Solution of 1—10 percent, highly 
endorsed. Cocainization is necessary after using on 
account of the interior smarting ; a 20 per cent, co- 
caine solution may be necessary after the stronger 
solution. (T. 98.) 

Sodium Formate: — Has proved of great service; 
may be used in solutions of 5-20 grains to half an 
ounce each of glycerine and water, or an ounce of 
water alone. As an insufflating powder it is com- 
bined with starch, 1 part to 4 of starch. This is 



562 DIGEST OF EXTERNAL THERAPEUTICS. 

blown on the ulcerated spots only. As a pigment it 
is employed in advanced cases in the strength of 40— 
60 grains to the ounce. (F.) 

Ligno- Sulphite: — By inhalation, 10-30 per cent, 
solution, relieves cough and dysphagia and improves 
the ulcers. (T. 98.) 

Hydrarg. Bichlorid.: — Recommended as a spray as 
follows : 

Hydrarg. Bichlorid., grs. iv. 

Ammon. Chlorid., grs. x. 

Glycerini, ^ij. 

Aquae, ^viij. (Al.) 

For submucous injection when there is local tume- 
faction without ulceration : 

Pyoktanin, 2 per cent, solution. 
Aristol, 2 per cent, solution. 
Phenazonum, 50 per cent, solution. (T. 96.) 
For intra-tracheal injection : 

Camphor, 

Menthol, aa grs. v. 

Albolene, ■ gi. (T. 98.) 

TUBERCULOSIS OF THE LUNGS: 

Iodoform Inunction: — This method has recently 
been introduced in the Metropolitan Hospital, Black- 
well's Island, by Dr. W. B. Keiser, of the house staff, 
■with the approval of the author. The following oint- 
ment is carefully prepared : 

Iodoform., ^ss. 

Ol. Anisi, M. x. 

Ol. Gaultherae, gii. 

Ol. Olivse, 

Lanolini, aa ^v. 

This is administered after the same plan as mercurial inunctions; 



TUBERCULOSIS. 563 

that is, rubbing the flexor surface of one arm one day, that of an- 
other the next, then the chest, abdomen, back, etc. After the dif- 
ferent surfaces have had the inunction applied, the process is re- 
peated and kept up until there is some indication of change. The 
author has observed some good effects from this method and no 
bad results. 

Inhalations: 

Creosote: — Lessens expectoration and deodorizes, 
but contra-indicated when there is tendency to haem- 
orrhage, viz: 

Creosote, 
Ethyl Iodide, 
Turpentine, equal parts. 
10-20 drops in inhaler. 

Creosote, 
Eucalyptol, 

Turpentine, equal parts. 
10-20 drops in inhaler. 

Creosote, 
Thymol, 

Alcohol, equal parts. 
10-20 drops in inhaler. (Sm.) 

Thymol: — The following formula suggested by Dr. 
C.-C. Rice is useful : 

Menthol, 
Thymol, 

Carbolic Acid, aa grs. v. 

Oil of Eucalyptus, gii. 

Oil of Pinus Silvestris, giii. 

Teaspoonf ul to a pint ' of boiling water, or a few drops inhaled 
from cotton. 

Eucalyptus: — The oil poured on boiling water, or 
eucalyptus water in a steam atomizer, when ex- 
pectoration is fetid. (Sm.) 
Terebene: — Less active than other agents as a 



564 DIGEST OF EXTERNAL THERAPEUTICS. 

germicide, but more stimulating ; useful in combina- 
tion with other remedies. 

Tr. Benzoin Comp.:— 1 drachm, to a pint of boiling 
water. 

Tar Water: — Heated, and the fumes inhaled. (F.) 

Iodoform: — 4 per cent, solution in turpentine, or 1 
drachm to turpentine 1 ounce; 3 to 4 drops at high 
temperature. (Sm.) 

Iodine: — Sometimes used, viz: 

Sol. Iodine (Iodine, Potass, iodide, each 

grs. iij, Alcohol, 5i), Zi-w. 

Water, ^ v. 

Place in a suitable inhaler and expose to heat. 

Tr. Conium may be added to lessen its irritating 
qualities. (F.) 

Ethyl Iodide: — This will give the effect of iodine 
combined with a sedative action. It may be inhaled 
directly from a vial or dripped upon the sponge of 
Yeo's perforated zinc respirator. The frequency of 
its administration will depend upon the severity of 
the case, and its duration upon the immediate effects 
shown. Vertigo will be produced if inhaled too long. 
The average time is five minutes, the average fre- 
quency six times a day. (F.) 

The following is a formula for inhalation : 

Turpentine, gtts. v. 

Glycerine, 3 i. 

Water, gi. (F.) 

Peppermint: — Method of use as follows: Fasten on 
the nostrils a piece of linen folded once, on this a few 
drops of essence of peppermint are poured. The nos- 
trils should previously be greased to avoid irritation, 
then the patient should take eight or ten deep inspi- 
rations with closed mouth, repeating the procedure 
every fifteen minutes for a time. (Sj.) 



TUBERCULOSIS. 565 

Guaiacol: — The following is to be used for impreg- 
nating the atmosphere of the room: 



Guaiacol, 


if iss. 


Eucalyptol, 


p 3ii. 


Carbolic Acid, 


%\, 


Menthol, 


ZJ- 


Thymol, 


giiss. 


Ess. Cloves, 


ji -M xv 


Alcohol (at 90 ) 


q. s. ad. Oij. 



Of this, 1 ounce is placed in the bottle of the large atomizer of 
Lucas Championniere, the bottle of which is two-thirds full of 
water. This is sprayed in the patient's room for two hours daily, 
and is claimed to form an important adjunct of treatment. (Sj. ) 

Sprays : 

Serve to cleanse and deodorize the pharynx and 
tipper respiratory tract, and assist in relieving dys- 
phagia and other distressing throat symptoms. 
The following may be used: 

Guaiacol: — Especially efficacious as a deodorant in 
all forms of tubercular catarrh. 1 part to 600 of 
water. (F.) 

Hydrogen Peroxide: — 1 part to 8; stronger if de- 
sired, repeating applications until froth has been 
w ashed away. 

Boric Acid: — Grs. x-xx-gi. 

Chlorine Water: — 31— gi. 

Potass Permang. — Grs. i-viii-§i. 

Sulphurous Acid: — M. x— ^i— |i. 

Lactic Acid: — M. vi— 3!— gi. 

Oil of Turpentine: — Gtt.i— v, Glycerine gi, Water gi. 

Salicylic Acid:— Grs. v-gi. (F.) 

Creosote, ^i-Tr. Benzoin Comp. sii, Distilled Ham- 
amelidis, Water, Glycerine aa ^iss ; inadvisable when 
there is a tendency to haemorrhage. (Sm.) 

Cocaine: — In solutions as mentioned for tuberculo- 



566 DIGEST OF EXTERNAL THERAPEUTICS. 

sis of the larynx for the relief of the dysphagia. (An.) 

For intracheal injections: 

Guaiacol, 2 per cent. 

Menthol, 10 per cent. 

Olive Oil, 88 per cent. 

1—2 drachms are rapidly injected during inspira- 
tion. Coughing may be avoided by quickly passing 
the nozzle of the syringe through the rima glottidis 
and injecting into the trachea. It is claimed there is 
no discomfort, and that the relief of the dyspnoea is 
marked. (Sj.) 

Guaiacol may also be administered by rectal in- 
jection. Milk forms an excellent expecuent for this 
purpose; dissolve 1 part in from 20-30 of milk. The 
solution keeps indefinitely, and readily mixes with 
water. 

For the chest pains which accompany advancing 
tuberculosis, the various mildly counter-irritant and 
soothing liniments and embrocations will assist as 
palliatives. For the dyspnoea the following rubbed 
on the chest may be employed : 

Croton Oil, 1 part. 

Oil Cajuput, 

Alcohol, each 3 % parts. (Al. ) 

Sometimes an anodyne gargle will be found to 
afford relief to the cough and throat. For this pur- 
pose the following are suggested : 

Tr. Opii Camphorat., 
Tr. Benzoin., Comp., 

Tr. Kino, aa %i. 

Dilute with water and gargle. 

Or, 

Tr. Opii Camphorat., 
Aq. Menthol. Pip., 

Glycerini, aa, %i. 

Dilute with water and gargle. (Sm. ) 



TUBERCULOSIS. 567 

Antiphthisin: — This is an sozalbumin isolated by 
Klebs from cultures of the tuberclar bacilli. Klebs 
maintained that the remedy was entirely destitute 
of the toxic properties of tuberculin, the alkaloids 
and toxalbumins of which were eliminated. In 
from 80—90 per cent, of a series of cases of pulmon- 
ary tuberculosis, the administration of the remedy 
was attended with improvement and in the early 
stages the disease was arrested and apparently 
cured. (F.) Antiphthisin is usually given hypo- 
dermically; the dose for adults should commence 
with one-tenth of a c. c, to be increased daily by the 
same amount until five-tenths have been reached. 
This maybe repeated for several days or a week, and 
again increased by tenths as heretofore. When 1 
c. c. has been reached, repeat this dose for a week or 
more, and when distinct improvement is manifest, as 
is usually the case, this dose may be continued for a 
longer period. It is rarely necessary to exceed two 
c. c, although much larger doses are well tolerated 
without producing disagreeable symptoms. The 
remedy may be continued in doses of 1 to 2 c. c, 
according to the results obtained and the character 
and stage of the disease, for several months, when it 
may be intermitted, especially if the results are such 
as to point to the entire arrest of the malady. But 
even in these cases and in those where all symptoms 
have disappeared, it is well to repeat the series of in- 
jections after an interval of one or more months, 
during which time the patient should be kept under 
observation. (T. 97.) As much as 10 c. c. given 
daily for several weeks has been used and it has also 
been administered by rectal injection. It is recom- 
mended only in the earlier stages of the tubercular 



568 DIGEST OF EXTERNAL THERAPEUTICS. 

process. When larger amounts than 1 c. c. are 
given, the dose should be divided — one-half being ad- 
ministered in the morning and the other at night. If 
local irritation is produced, the medicant may be di- 
luted with a small quantity of distilled water and in- 
jected into the rectum. In this country antiphthisin 
may be obtained from Dr. Yon Ruck, and in Europe 
from the laboratory of Klebs, in Strasburg. (F.) 

Maragliano's Serum: — This was obtained from the 
dog, the ass and the horse, and was presumed by its 
discoverer, Maragliano of Genoa, to contain a 
tubercular antitoxin. He recommends that 1 c. c. 
should be injected systematically every two days. 
He first began with double the dose, but found that 
the smaller amount was sufficient. In continuous 
fevers, with persistent high temperature, as much as 
5 and even 10 c. c. may be injected in one dose, 
repeating in from five to eight days, and so on, when 
after two or three days an impression will be found 
to have been produced in the patient's temperature. 
Maragliano sums up the following results from his 
statistics : " 1. The remedy has been proved to be quite 
innocuous. 2. It has caused subsidence of fever. 3. 
It has had a modifying influence on the morbid local 
processes. 4. It has caused the bacilli in the sputum 
to diminish in number or entirely disappear. 5. It 
has brought about a notable increase of -weight. 6. 
It has had a beneficial effect, more or less marked, ac- 
cording to the gravity of the disease, in 91.79 per 
cent, of the cases. 7. It has cured or put on the road 
to cure nearly all the patients with circumscribed, 
non-febrile forms of the disease. 8. It has even cured 
cases in which cavities had formed. 9. It may be 
used to advantage in all forms of tuberculosis." 



TUBERCULOSIS. 569 

Tuberculin: — A careful study of the results ob- 
tained by the use of this remedy in tuberculosis has 
led to the general conviction that its benefit is not 
only doubtful, but that, unless it is employed with 
discretion and care, harm may follow its administra- 
tion. 

According to Drs. Grasset and Vedel this remedy 
has fallen undeservedly into disrepute, owing, it is 
claimed, to the fact that probably too large doses 
have been employed, the most serviceable dose 
being from two-tenths to three-tenths of a milli- 
gramme for the first and half a milligramme for the 
second injection. From experiments on fourteen 
cases, these writers arrive at the following conclu- 
sions: 1. In doses as above stated the remedy is quite 
harmless and there is no risk of aggravating an ex- 
isting tuberculosis. 2. In certain cases the action was 
sufficient to make a diagnosis of tuberculosis. 3. In 
two cases the reaction was doubtful or absent. 4. 
Absence of reaction was found not to exclude the 
presence of tuberculosis, since there was none in three 
cases. This is explained on the supposition that the 
organism had become accustomed to the toxin, when 
these small doses would be ineffectual. 5. One case 
showed a slight reaction. (T. 97.) 

It is advised that injections of tuberculin should not 
be repeated until twenty-four hours after all signs of 
irritation from the previous dose have disappeared. 
Another plan of doses than those above stated has 
been advised, viz: One-tenth of a milligramme in- 
creased by one-tenth at each succeeding administra- 
tion until one milligramme is reached, when the dose 
may be increased more rapidly, according to the 
tolerance of the patient. 



570 DIGEST OF EXTERNAL THERAPEUTICS. 

Physical Exercise: — Treatment and prophylaxis 
by lung gymnastics form a valuable adjunct when 
vital capacity is low and chest expansion limited. 
Forcible expansion of the apex will be found useful in 
incipient cases. (Sj.) 

Respiratory Differentiation Therapy with the 
Pneumatic Cabinet: — The more general adoption of 
this method for the treatment of diseases of the lungs 
is urged by Solis Cohen. Inspiration of condensed 
air and expiration into rarefied air alone or in com- 
bination are the expedients generally employed. 

Inspiration of Condensed Air: — Indicated in 
chronic pulmonary tuberculosis at any stage of gen- 
eral softening with cavities, but particularly in the 
early stages when deficient respiration, anaemia, 
poor circulation and digestive disorders suggest 
tuberculosis, even in the absence of pronounced phys- 
ical signs and of bacilli in the sputum. In such 
cases it may be employed, in place of change of 
climate, for those patients compelled to con- 
sider expense. The good results from this pro- 
cedure are most strongly urged. When there is any 
weakness of the pulmonary vessels, or when it is in- 
advisable to increase the blood pressure in the brain, 
or kidneys, or other abdominal viscera, the method 
is contra-indicated. 

Expiration into Condensed Air: — Should be com- 
bined with inspiration of condensed air for the relief 
of congestion and stimulation of absorption as in 
consolidation persisting after pneumonia, and in 
chronic pleurisy with effusion. This is highly rec- 
ommended for tuberculosis, but is inferior to inspira- 
tion of condensed air with expiration into rarefied 
air. This method is also recommended in cases 



TUBERCULOSIS. 571 

where the expiration is imperfectly performed, as a 
means of strengthening the respiratory muscles. It 
has been found of service in convalescence from pul- 
monary tuberculosis and as a prophylactic against 
the same. 

Expiration into Rarefied Air: — Combined with in- 
spirations of condensed air, may be employed when 
it is desired to increase the activity of the circulation 
of the amount of air in the lungs, or to get rid of ac- 
cumulations in the alveoli, bronchi or quiescent cav- 
ities. 

Inspiration of Rarefied Air: — Is employed to 
strengthen the muscles of inspiration by increased 
exercise. It is indicated in cases of contracted 
thorax, as a preventative against pulmonary disease. 

(F.) 

In spite of the high commendations, the use of the 
pneumatic cabinet has rather declined than increased. 
This may be owing to the impossibility of its practi- 
cal application, for, in order to be efficient, the appa- 
ratus should be used two or three times a day, with 
intervals of rest ; therefore, unless the patient has one 
at home or is in a hospital provided with one, the 
treatment is of no avail. 

Fresh Air Cure: — The plan of this treatment is to 
place the patient in as perfect a condition as possible 
as far as air and hygiene are concerned. It has been 
pursued at the Hospital of Ormesson, situated in the 
remote part of the plateau of Champigny , at an eleva- 
tion above the sea of about 308 feet and overlooking 
the valley of the river Marne. The buildings serving 
as dormitories consist of two immense w^ooden pa- 
vilions, the capacity of which is not less than 101,710 
cubic feet of air, constantly renewed by perforated 



572 DIGEST OF EXTERNAL THERAPEUTICS. 

windows. No special medication is employed except- 
ing cod liver oil in very cold weather. Unless there 
are contra-indications each patient is bathed twice a 
week, thoroughly soaked, then vigorously rubbed in 
order to obtain a complete reaction of the skin. Very 
good results are claimed. (T. 97.) 

Climate: — The importance of open air life and sun- 
light cannot be too greatly emphasized. When pa- 
tients can spend all day out of doors, and when in- 
doors live in a pure atmosphere, they will do well. 
There is no climate where patients can be sent indis- 
criminately ; a suitable locality must be selected for 
each case. Generally speaking, a dry, equable tem- 
perature should be chosen ; yet dryness is not by any 
means always a requisite, as evidenced by the bene- 
ficial effects of Torquay and Falmouth, in England, 
places noted for humidity. Low altitudes are seda- 
tive and soothing, high are stimulating and invigor- 
ating. The extreme cold of an Adirondack winter 
and the mild temperature of Florida and the West 
Indies must both be considered. Sea voyages may 
prove beneficial to those who are fond of the sea and 
are naturally good sailors. 

In regard to altitude the f ollowing are the conclu- 
sions of Dr. F. I. Knight: * 

High altitude is most likely to prove of benefit 
when the age is under fifty, temperament phlegmatic 
rather than nervous, with weak heart, feeble pulse, 
and inability to resist cold. Those showing irrita- 
bility from disease are not to be included in the latter, 
as they are generally benefited. 

As regards disease those with : 

* Transactions of the American and Climatological Assn., I 



TUBERCULOSIS. 573 

1. Early apical affections, with little constitu- 
tional disturbance, are most benefited. 

2. Cases of more advanced disease, with evidences 
of consolidation, without excavation or any serious 
disturbance do well. When the apices are both much 
involved, the pulse generally over 100, and the tem- 
perature above 100°, it is better to begin with a 
low altitude. 

3. Hemorrhagic cases, early cases with haemopty- 
sis and without fever, or much evidence of disease, 
are benefited. 

4. Patients with advanced disease ; those with 
cavities or severe hectic symptoms, should not go to 
high altitudes. A small quiescent cavity is not a 
contra-indication ; hectic symptoms on the other 
hand are. 

5. Patients in an acute condition should not be 
sent. 

6. Patients with fibroid phthisis are not suitable 
subjects. 

7. Convalescents from pneumonia and pleurisy 
usually do well. 

8. Advanced cases of laryngeal tuberculosis may 
not do worse than elsewhere, if good local treatment 
and freedom from dust can be obtained. 

9. When other diseases complicate, much care is 
necessary. Cardiac dilatation and hypertrophy, ner- 
vous palpitations, and diabetes are contra-indica- 
tions. A cardiac murmur, the result of an old endo- 
carditis, with no sign of enlargement or deranged cir- 
culation, should not deter, neither is syphilis a con- 
tra-indication. 

The following classification of localities, according 
to Dr. G. A. Evans, will be found useful : 



574 DIGEST OF EXTERNAL THERAPEUTICS. 

1. Cool and moderately mild; general elevation 
2,000 feet ; western slope of the Appalachian chain, 
Adirondacks, Catskill, Allegheny, and Cumberland 
Mountains. 

2. Moderately warm and moderately moist; 
western North Carolina (Asheville), elevation 2250; 
western South Carolina, Aiken, Georgia, Marietta, 
and Thomasville. 

3. Warm and moist. Florida (equable), southern 
California, coast region (equable). 

4. Warm and moderately dry. Elevation 2,000 
feet. Southern Texas, southern California, inland. 

5. Cool and moderately dry; elevation 1000 feet; 
Minnesota, Nebraska, Dakota. 

6. Cool and dry; elevation from 4000 to 7000 feet. 
Montana, Wyoming, Colorado, northern New Mexico, 
western Kansas. 

7. Warm and dry; elevation 3000 to 5000 feet, 
southern New Mexico, southern Arizona. (Ev.) 

Sanitaria: — These institutions have demonstrated 
their utility beyond all question. Although they 
have as yet only been established at moderate eleva- 
tions, their statistics show twice as many cures as 
the open air treatment in the same altitude. The 
rigid hygienic rules and the constant intelligent 
supervision of the daily life of the patient have 
doubtless much to do with bringing about these re- 
sults. The comparative nearness and cheapness of 
these institutions place them within the reach of per- 
sons of moderate means, to whom the expenses of a 
long journey and hotel bills are matters of consid- 
eration. 



TYPHOID FEVER. 575 



TYPHOID FEVER. 

The use of cold baths is now recognized as having 
not only reduced the mortality, but also the fre- 
quency of complications, excepting haemorrhage. 
Some practitioners employ them regularly at 6 a.m., 
1 to 3 p. m., and 7 p. m., but the majority prefer to 
administer them with more or less frequency accord- 
ing to the range of temperature. 

Brand Treatment: — A bath is prepared at a tem- 
perature of 65°-100°, filling the tub two-thirds full ; 
the patient, if sweating, should be dried, and the 
bladder emptied. To avoid annoyance it is better to 
screen the bath during preparation. When all is 
ready the patient is covered with a sheet and gently 
placed in the tub. While in the bath vigorous rub- 
bing is applied, except on the abdomen ; this is essen- 
tial to prevent cyanosis and collapse. An ice com- 
press should be applied on the head or effusion of ice 
water poured on it. This measure is regarded as 
important in cases with severe nervous symptoms, 
and should be continued for fifteen minutes. The 
bed should have been previously provided with a 
rubber sheet and blanket, the patient should now be 
rubbed dry and wrapped in a blanket, hot water 
bags applied to the extremities and the rubber sheet 
and under blanket withdrawn. (Gn.) 

As soon as the patient ceases to shiver after the 
bath the temperature should be taken. After an in- 
terval of three hours it may be again taken ; if it is 
then 102° or above, the bath is repeated. If 102° or 
below, but above 101°, it is taken again in an hour ; 



576 DIGEST OF EXTERNAL THERAPEUTICS. 

if below 101° and above 100° in ten hours. When 
the temperature reaches 102.2° a bath may be given, 
provided three hours have elapsed since the last. 
(Ty.) 

Von Ziemssen's modification of the Brand bath is 
what is known as the graduated bath. The water is 
prepared at a temperature of 85°— 90° and gradually- 
lowered to 40°. The duration of the bath is half an 
hour. Rubbing is also necessary. While adding the 
cold water care must be taken not to allow it to 
come in contact with the skin. (Gn.) 

Cold Sponging: — For the reduction of temperature 
this may sometimes be preferred to the cold bath, as 
the liability to shock is lessened, and the exhausting 
effects of the patient's removal from bed obviated. 
Commence with water at a temperature of 90° and 
gradually lower to 70° or less according to the bodily 
temperature, which must be carefully watched. An 
important feature is the exposure of the surface to 
the atmosphere during the sponging, as the evapora- 
tion rather than the temperature of the water cools 
the body. It is advisable to allow a film of water 
to remain on the surface. The sponging should con- 
tinue for about twenty minutes. Alcohol is some- 
times used instead of water, especially in hot weather, 
when it is preferable. Sponging with ice water is 
also recognized. (Gn.) 

Ice Cradle: — This consists of an ordinary iron cra- 
dle sufficiently long to entirely cover the patient, 
who lies underneath covered with some light muslin. 
Attached to the cross-bars are small zinc baskets 
filled with ice. The baskets are covered with lint to 
prevent any condensation of moisture falling on the 
patient. The cradle is covered with a counterpane 



TYPHOID FEVER. 577 

except at the two ends, which are left open to allow 
a constant interchange of air. Hot bottles are placed 
at the patient's feet. Before the cradle is used the 
patient should be sponged with tepid water. Fen- 
wick, who has offered this method as a substitute for 
the bath, claims it is as effective in reducing the tem- 
perature. (Gn.) The advantages are the avoidance 
of shock of the cold bath and the removal of the pa* 
tient from bed. 

Cold Air Treatment: — Subjecting the patient to 
cold air from a freezing machine has been suggested 
for hospital use by J. Murray Gibbes, in the Aust . 
Med. Gaz., Ap. 24, 1897. (T. 98.) It would seem 
that the ice cradle of Fen wick would accomplish the 
same end in a much more simple way. 

Wet Pack: — Not as effective as the baths, still is 
very useful in reducing temperature. It has the merit 
of convenience, and may be used several times a day, 
the patient remaining in it from five minutes to an 
hour, according to the temperature. (B.) 

Enemata:— Will sometimes be necessar}^ for consti- 
pation. 

For thrombosis of the femoral vein elevation of 
the part and the following ointment : 

Ung. Ichthyoli, 

L,anolini, aa 3ii- 

Ung. Belladonnae, q. s. ad. gi. (An.) 

Rectal Tube: — When tympanitis is very distress- 
ing this may be cautiously used ; sometimes large 
quantities of gas are thus discharged. 

Ice to the Abdomen: — Should be employed as an 
adjuvant in cases of haemorrhage. 

Morphine: — Should be given hypodermically when 
there is sharp sudden pain in the bowels in order to 
secure absolute rest, and for checking haemorrhage. 
38 



578 DIGEST OF EXTERNAL THERAPEUTICS. 

(An.) It may also be administered in some cases for 

insomnia. (Ty.) 

Ergotin: — Hypodermically, repeated every hour for 

severe haemorrhage. 
Turpentine Stupes: — For meteorism. (An.) 
Disinfection: — The following are the conclusions of 

W. Gilman Thompson, M. D., read at the N. Y. State 

Med. Soc, on Jan. 28, 1897: 

1. The best disinfectants for typhoid urine and 
stools are: (I.) A 1—500 acidulated solution of corro- 
sive sublimate; (II.) a 1—10 crude carbolic acid solu- 
tion; (III.) chlorinated lime. 

2. Owing to the possibility of injury to plumbing, 
the carbolic acid solution is preferable wherever 
plumbing is concerned. The lime is best for country 
use in privies and trenches. 

3. The disinfectant should be thoroughly mixed 
with the stool, and left in contact with it for fully 
two hours. Enough of the disinfectant must be 
added to completely cover the stool with the solu- 
tion. 

4. The bed-pan should be kept ready filled at all 
times with at least a pint of the disinfectant, into 
which the stool is at once discharged, and should be 
filled with scalding water and one of the disinfecting 
solutions. 

5. Rectal thermometers, syringes, tubes, and all 
utensils coming in contact with the faecal matter 
must be disinfected with the corrosive sublimate or 
carbolic acid solution. 

6. After each stool the patient's perinaeum and ad- 
jacent parts should be washed and sponged with a 
1-2000 corrosive sublimate solution. 

7. Nurses and attendants should be cautioned to 



ULCERS. . 579 

wash their own hands thoroughly, and immerse them 
in a 1-1000 corrosive sublimate solution after 
handling the bed-pan, thermometer, syringe or pa- 
tient, or giving sponge or tub baths. 

8. All linen or bed clothing used by the patient 
should be soaked in a 1-20 carbolic acid solution, 
and subsequently boiled for fully two hours. 

9. Disinfection of the stools should be begun as 
soon as the diagnosis of enteric fever is established, 
and should be continued for ten days after the tem- 
perature has remained normal. 

10. In localities where a proper drainage system is 
lacking, the stools should either be mixed with saw- 
dust and cremated, or buried in a trench four feet 
deep after being covered with chloride of lime. 



ULCERS. 

Cleanliness, Antisepsis, Avoidance of Irritation, 
and complete physiological Rest are the essentials of 
treatment. First cleanse with warm water and 
some good soap, Castile or medicated, scrub with 
brush the surrounding skin and bathe thoroughly 
with an antiseptic lotion, the strength of which will 
depend upon the nature of the lesion ; generally it 
should be mild to avoid irritation, using such lotions 
as saturated solutions of boric acid, or sublimate 1— 
6000, though some writers advocate much stronge r 
applications. After this the selected dressing may be 
applied. When the ulcer is situated on the lower ex- 
tremity, rest by means of elevation of the limb or 
placing the patient in bed. Not a few ulcers which 
have resisted all other efforts for inducing resolution 



580 DIGEST OF EXTERNAL THERAPEUTICS. 

will at once begin to heal when the recumbent posture 
is maintained. The element of rest in bed applies to 
the treatment of ulcers of all varieties when situated 
on the lower extremity. 

There are a vast number of remedial agents which 
have been recommended for this lesion, many of 
which, in view of modern antisepsis and asepsis, are 
now obsolete. 

The different varieties of ulcers with some of the 
well-attested methods of treatment are as follows : 

HEALTHY ULCERS: 

Avoid irritation and permit the surface to cicatrize. 
If large, apply the following : 

Hydrarg. Chlor. Mitis, 

Ung. Zinc. Ox. Carbolat., aa £i. 

Over this place ' ' protective ' ' or gutta percha. 

Simple antiseptic dressings are, as a rule, better than 
ointments. 

For stimulation when healing is slow, Nitrate of 
Silver or Chlorat. Hydrat., grs. x-gi. (A.) 

IRRITABLE ULCERS: 

Dusting Powders: — Those of a soothing, drying 
character, Airol, Acetanilid, Iodoform, Iodol, etc. 

Cocaine: — With belladonna ointment, 5 grains to 
the ounce; or, Fid. Ext. Grindelia diluted with water 
or glycerine. (Sm.) The Curette may be used for re- 
moval of sensitive granulations. (A.) 

INFLAMED ULCERS: 

When there is extensive inflammation, continuous 
warm antiseptic baths will convert the sore intp a 
simple one. (Den.) 



ULCERS. 58 1 

Calendula: — Very useful; a solution of 1 part to 
5-6 of a l 1 /^ per cent, solution of carbolic acid. 
Soothing in action. Used also for ulcers of other va- 
rieties. (M. H.) 

FUNGOID ULCERS: 

Employ agents which will constringe vessels and 
apply pressure with cotton bandage. The following 
solutions are useful : 

Copper Sulphate, grs. i— x— §i. 

Zinc Sulphate, grs. i— x-gi. 

Silver Nitrate, grs. i— x-^i. 

Nitrate of Silver Stick. (Den.) 

(EDEMATOUS ULCERS: 

This condition is likely to occur after the prolonged 
use of wet dressing or poultices. The margin of the 
nicer may appear fairly healthy, but the granulations 
elsewhere will have become swollen, pale, semi-trans- 
parent and friable, exuding watery pus. Treatment 
must be stimulating, including applications of the fol- 
lowing nature : 

Resin Ointment, Balsam Peru, Astringents and 
Mechanical Support. (Den.) 

INDOLENT, CALLOUS OR CHRONIC ULCERS: 

For cleansing and disinfecting, wash ulcer with 
soap and water. Saturate surrounding skin with 
turpentine and scrub with 4 per cent, carbolic acid 
solutions or sublimate 1-500, using a nail brush; 
cleanse the ulcer itself with zinc chloride 1-40. The 
ulcer may now be painted with pure carbolic acid. 
Having gotten rid of septic material, cease applying 
irritants and dress with boric acid (saturated solu- 



582 DIGEST OF EXTERNAL THERAPEUTICS. 

tion), first applying Lister's oiled silk to protect sore 
from irritation of lint; change daily. (Tre.) 

If cicatricial margin prevents flow of arterial blood, 
Radiating Incisions may be made ; if venous return 
is impeded, use the Curette, freely disinfect with the 
solution of zinc chloride or hydrogen peroxide, and 
subsequently apply antiseptic dressings. (Den.) 

Copper Sulphate: — Useful in ulcers occurring in 
broken down constitutions ; first poultice for several 
days ; after the surface is fairly clean apply lint 
soaked in a solution (grs. v— x— gi), then bandage 
from toes to knee. (Al.) 

Tr. Aloes: — After cleansing and antisepsis of the 
ulcerated surface, dry carefully with absorbent cot- 
ton ; then if the sore is superficial, paint it once with 
the tincture of aloes ; if deep, paint it twice ; next a 
piece of impermeable linen is applied and the leg is 
wrapped entirely in aseptic gauze and cotton. (T. 98.) 

Unna's Dressing: — This is to be used when the skin 
is diseased, apart from the ulcer. The method is as 
follows : After prolonged cleansing of the ulcer with 
soap and hot water, brush it with rough antiseptic 
gauze, and disinfect it with some antiseptic wash* 
Next the entire region affected with varicose eczema 
is coated with a thick layer of Lassar's paste (see 
Appendix II), and the ulcer itself is dusted with iodo- 
form, aristol or dermatol, and covered with cotton. 
The entire leg is then painted with Unna's paste, 
melted and applied with a brush. The parts that are 
covered with Lassar's paste must also be coated 
with Unna's paste, which is as follows : 

Water, 

Glycerine, aa ^iiss. 

Gelatine, 

Zinc Oxide, aa, grs. ccc. 



ULCERS. 583 

The leg is bandaged with tarletan, which has been soaked in hot 
water. The bandage is drawn tight in order to obtain moderate 
compression; over this a dry bandage is placed. In from two to 
six days the discharges will pass through the bandage, which must 
then be changed. Under this treatment secretions dry up, and the 
bandages are renewed only once a week. (T. 98.) 

Nitrate of Silver: — A valuable stimulant in leg ul- 
cers, and those f ollowing burns. When cicatrization 
has begun, care must be taken not to touch the pink 
line which surrounds the granulations and skin. (Al.) 

Airol: — Useful in ulcers of leg, particularly when 
complicated with eczema. As a dusting powder it 
is superior to iodoform. (T. 97.) 

Europhen:— Same indications as for airol. (T. 97.) 

Euphorbium: — 1 part to 20 as ointment. (F.) 

Hydrastine Hydrochlor.: — Grs. v— xxx-§i of cerate, 
especially on mucous surfaces. 

Dermatol: — Checks serous exudation and stimu- 
lates granulations ; useful as a dessicant. 

Iodoform: — Often irritating to varicose ulcers, and 
those attended with eczema; more useful for venerea' 
than non-specific sores. (Al.) 

Chloride of Sodium: — 10 parts to 1 of powdered 
menthol. Mix thoroughly and use as dusting pow- 
der after cleansing surface. (T. 98.) 
Sozoiodol: — Similar inaction to iodoform, only more 
effective. (Al.) 

Tr. Ferr. Muriat.: — An old remedy for indolent and 
varicose sores, painted over daily, has been highly 
praised. (Rd.) 

Ung. Basilicon, Ung. Bal. Peru, Ung. Hydrarg. 
Nit.: — Old standard stimulating applications, still 
much used. (N.) 

Naphthol:— 5-10 per cent, ointment. (Sm.) 



584 DIGEST OF EXTERNAL THERAPEUTICS. 

Creosote: — The following combinations when the 
discharge is excessive : 

Creosoti, M iv. 

Tr. Galbani, 3 ii. 

Aquae, Jii. (Sn.) 

Bovinine: — As a digestive to remove sloughs has 
been used, and, it is claimed, with some success. (Tre.) 

Monochloratic Acid and Trichloratic Acid: — Give 
satisfactory results when caustic action is required. 
Healing takes place with little or no cicatrization. 

(F.) 

VARICOSE ULCERS: 

Aristol: — 10 per cent, ointment is excellent. (Sn.) 

Hamamelis : — The cerate, ointment or compress. 
(Rd.) 

Creolin : — Gauze dipped in a 2 per cent, solution 
and covered with wool compress or gauze kept con- 
stantly wet. Sloughs and odor rapidly disappear. 
(Sj.) ' 

Pyoktanin: — After cleansing with a solution of so- 
dium bicarbonate apply a solution, 5 grains, to wa- 
ter,3ij. Apply to entire base and margin after drying ; 
cover with absorbent cotton, then with Martin's 
elastic bandage. (Sj.) 

Europhen and Boric Acid: — 1 part of former to 
1-3 of the latter. (Sj.) 

Strapping: — With adhesive plaster. Commence at 
base of the toes and strap all the way up to about 
three inches above the ulcer. This method has been 
successful in the author's hands. The entire foot, ex- 
cept the heel, should be enveloped. 

Traumatol: — As dusting powder or ointment em- 
ployed same as a iodoform, said to have been used 
with great success. (F.) 



ULCERS. 585 

Curettage: — The following method is recommended. 
First wash ulcer thoroughly with soap and water, 
giving a good scrubbing with stiff nail brush ; then 
curette thoroughly and free the edges from their at- 
tachment, check haemorrhage with compresses soaked 
in a 2 per cent, solution of carbolic acid ; now ap- 
ply strips of diachylon plaster, and cover with ab- 
sorbent cotton. If granulations become exuberant, 
apply caustics. (T. 97.) 

Tr. of Aloes: — Applied as already described is use- 
ful for ulcers of this type. 

Elastic Stockings: — The integrity of the circulation 
should be restored by mechanical means. For this 
purpose a properly fitted elastic stocking is invalua- 
ble. 

Martin's Elastic Bandage:— Is also excellent, but 
requires care in application. When neither the band- 
age nor stocking is available, a muslin or flannel 
roller should be used. (W.) . 

FOUL, SLOUGHING AND GANGRENOUS ULCERS: 

For cleansing and irrigating, the following solu- 
tions : 

Mercuric Bichlorid., 1-2000-3000. 

Potass. Permang., 15-60-grs. Oj. 

Carbolic Acid, 1-40. 

Hydrogen Peroxide, pure or diluted. 

Styron, 1-12. 

Trichlorphenol, 1 or 2-100. 

Creosote Water, Mi-|i or stronger. 

Bromium, 1-1000. 

Labarraque's Solution. 

Sodium Hyposulphite, 1-5—10 parts of water, 
kept in contact with lint will correct fetor and tend 
to establish healthy reaction. (Al.) 



586 DIGEST OF EXTERNAL THERAPEUTICS. 

Charcoal: — A number of small flat bags containing 
charcoal placed on foul surfaces will destroy the 
fetor. (F.) 

Peat: — In the form of fine powder, dusted on, has a 
good effect and tends to promote healthy granula- 
tion. It should be frequently repeated. (F.) 

Bismuth Sub-Iodide:— May be used for packing 
ulcer when it is impossible to apply dressing ; after 
which it may be sealed up. (Alz.) 

Creosote: — Undiluted, may be brushed on foul and 
indolent ulcers. (Al.) 

Xeroform: — In cases where cauterization has been 
applied it is most excellent dusted over surface. (F.) 

TUBERCULAR ULCERS: 

Local measures are of the utmost importance, the 
aim of treatment being the complete removal of the 
disease. 

Antiphthisine: — Applied to ulcers of this variety 
causes them to become clean and to show a tendency 
to heal. 

Menthol and Iodoform: — Equal parts ; better than 
iodoform alone. (Al.) 

Calcium Phosphate: — 1—100 in solution, with little 
free phosphoric acid, has succeeded, ^it is said, when 
other remedies have failed. (Al.) 

Mercury: — Calomel ointment and blackwash are 
recommended for lesions of the tuberculas syphilitic 
variety. (R.) 

Curette and Cautery: — These constitute effective 
measures. They should be followed by iodoform 
dressings. (Tre.) 

Excision: — This may be preferred, especially when 
followed by skin grafting. (Tre.) 



ULCERS. 587 

SCROFULOUS ULCERS: 

Treatment in the main similar to tubercular, with 
exception of antiphthisine. 

Phosphoric Acid: — 50 grains to 1 ounce of distilled 
water ; lint dipped in the solution and renewed three 
or four times a day has been employed. (Al.) 

Acid Nitrate of Mercury: — More or less dilute solu- 
tion. (Al.) 

PHAGEDENIC ULCERS See Phagedena: 



Unna's Method: — For an iodoform dressing and for 
stiffening an ordinary bandage in order to give sup- 
port and compression : 

1. Wash skin with soap and water. 

2. Apply an antiseptic lotion. 

3. Powder with iodoform. 

4. Take a double-headed bandage and apply, com- 
mencing at the middle of the sore. The bandage 
should be porous and over it is rubbed a mixture of 
gelatine and glycerine, 10 parts of gelatine, 40 of gly- 
cerine, and 40 of water, with some oxide of zinc. 
This is melted and rubbed into the bandage ; before 
it is set another bandage is dipped in hot water and 
applied. The bandages are renewed according to the 
amount of discharge, usually at first every day. They 
can be easily removed by the patient placing the leg 
in a pail of hot water. A bandage so applied gives 
good support. (Tre.) 

Ichthyol:— 25 per cent, aqueous solution is recom- 
mended in ulcers of all varieties. (Tre.) 

Alum: — In solution in relaxed and abundantly se- 
creting sores. (R.) 

Thiol: — Antiseptic and protective, 1 drachm to 



588 DIGEST OF EXTERNAL THERAPEUTICS. 

vaseline 1 ounce, or a powder thiol sec., 1 drachm, 
zinc, oxide, 2 drachms starch, 1 ounce, talc 2 ounces. 
(Al.) 

Tanniform: — 10 per cent, ointment or powder with 
starch same strength. 

Tumenol.: — 5-10 percent, ointment in slight super- 
ficial ulceration. 

Potass. Sozoiodolate: — An odorless and non-poi- 
sonous substitute for iodoform. Use pure or diluted 
with from three to ten times its weight of starch or 
talc. (F.) 

Terebene: — Used as a substitute for carbolic acid 
in antiseptic dressings. 

Alum: — Useful dessicant for suppressing fungoid 
granulations and to stimulate indolent and sanious 
ulcerations. It acts as an escharotic on tissues in 
process of growth. (N.) 

Hot and Cold Effusions: — During the process of 
healing, pouring hot water on the limb followed by 
cold is beneficial for restoring and equalizing the cir- 
culation in ulcers of the extremities. 

Massage: — Rubbing gently toward the body is 
often of service during the process of resolution, espe- 
cially when there is much oedema. 

SYPHILITIC ULCBRS See Syphilis. 



UREMIC POISONING. 

The Vapor or Hot Air Bath, or the Hot Pack, 
should be employed at once ; the latter is very efficient 
and less enervating. (Ty.) 

Pilocarpine: — Subcutaneously administered in con- 
junction with the hot pack, in doses of Ys of a grain 



UREMIC POISONING. 589 

of the muriate or less, is one of the most important 
remedies; if diaphoresis does not set in, repeat in half 
an hour. (Ty.) 

Jaborandi: — An infusion of the leaves gi, to water 
3iv. When cool strain, and inject into the rectum; 
acts almost as well as pilocarpine. 

Atropine: — -^ of a gr., hypodermically ; indicated if 
there is pulmonary oedema. 

Chloral Hydrate: — 1 drachm by the rectum may be 
used with good effect if convulsions persist; 15-30 
grains may be given to a child. 

Morphia: — Hypodermically, in large doses; V2 gr. 
was used by Prof. Loomis in uraemic convulsions 
complicating acute nephritis. Caution, however, 
should be observed in its use. (Ty.) 

Digitalis: — A poultice of leaves to the abdomen and 
lumbar region may be used (B.), 1 /^ gr. of the extract, 
hypodermically. (R.) 

Dry or 'Wet Cups: — Applied over lumbar region 
may prove of service. 

Intra- Muscular Injections:— These have proved 
effective and in the last stages of uraemia and eclamp- 
sia are really powerful agents. M. Dumarest, who 
appears first to have recommended the measure, 
sums up his experience in the following : " These in- 
jections exert the best influence on the toxic symp- 
toms due to changes in the kidney and even on simple 
albuminuria. Pulmonary oedema and anasarca are 
not contra-indications. The salt water probably 
acts as a tonic and antitoxic. (T. 98.) 

Hypodermic Injections of Salt Water: — Solutions 
of 1 per cent., may be given in extreme cases. 

High Enemata:— Moderately cool, have been ad- 
vised to promote diuresis ; also at blood heat with 1 
per cent, salt added. (T. 96.) 



590 DIGEST OF EXTERNAL THERAPEUTICS. 

Inhalations of Amyl Nitrate, Oxygen and Nitrogen 
combined for oppression in breathing ; hypodermics 
of Strychnine or Ether, especially the former, are 
measures to be considered when collapse is imminent. 



URETHRITIS IN FEMALES. 

(See also Gonorrhoea.) 

Tannic Acid: — Bougies, covered with this agent, 
according to Dr. Hicks, constitute one of the most 
efficient means of treatment in the specific form. 

Resorcin: — Injections of 3 per cent, solution are 
employed. After the discharge has diminished, which 
is usually the case in three or four days, increase the 
number of injections to three or four a day, and one 
at night. Continue injections after cessation of the 
discharge for some time. 

Zinc. Sulph.: — Craj^on of the sulphate inserted into 

the urethra has been used successfully in chronic 

forms. (Al.) 

Lavage of Urethra, with solutions of Corrosive 

Sublimate, 1-2000, or Potass. Permang., 1-250, 

have proved of service. (Sj.) 



URINE, RETENTION OF. 

Catheterize patient at once. If not successful try 
Hot Sitz Baths, Hot Fomentations to perineum and 
hypogastrium, or Hot Enemata. (Rd.) Allow pa- 
tient to hear water run from faucet. 

Pressure Over Supra-Pubic Region: — If the reten- 
tion is the result of spinal disease the urine may 



URTICARIA. 591 

sometimes be expelled by pressure over trie supra- 
pubic region without the use of the catheter. 

Aspiration: — When all other means fail use aspira- 
tor or trocar and canula. (CI.) 



URTICARIA. 

In addition to the following, the reader is referred 
to Pruritus : 

Cold Water: — Often relieves alone or with alcohol. 

Chloroform: — 31, with alcohol or cold cream ,^i. 

Camphor: — McCall Anderson's powder. (See Ery- 
thema.) 

Lime Water, Laurel Water, and Glycerine: — Equal 
parts. 

Chloral: — 3iij, aquas laurocerasi ^viii. 

Menthol: — About 20 grains to olive oil 1 ounce, or 
an ethereal solution, 1 drachm to the ounce. 

Carbolic Acid: — ^iii, glycerine ^i, water Oj. 

Benzoic Acid: — Saturated solution, or grs. x, wa- 
ter, gi. 

Alumnol: — 10 per cent, solution. (F.) 

The following pomade is recommended by Brocq : 

Acid. Carbolici, grs. xv. 

Ess. Menth. Pip., M. xv. 

Zinc. Oxidi, 3iij. 

Lanolini, ^ss. 

Vaselini, ad. ^ij. 

Before applying the above, use lotions of chloral. 

Bathing the parts with dilutions of Extract of 
Witch Hazel or Lemon Juice, solutions of Soda 
Bicarbonate, or Salts of Potassium, or Ammonia, 
occasionally affords relief. 

Change of climate in obstinate cases is often bene- 
ficial. 



592 DIGEST OF EXTERNAL THERAPEUTICS. 

UVULA— RELAXED OR ELONGATED. 

Astringent gargles of Alum or Tannin, and appli- 
cations of Nitrate of Silver will prove useful palli- 
tives. 

Some claim that Excision is the sole method by 
which a permanent cure can be effected. Care should 
be observed to excise only the mucous membrane. 
(Iv.,Ba.) 

VAGINISMUS. 

As this is a symptom of various diseased conditions 
affecting the genital track and surrounding parts, an 
examination should be made in order to locate the 
cause and thereby determine appropriate treatment. 

The morbid conditions which will give rise to this 
affection are : Urethral caruncle, inflammation and 
fissures of hymen, imperforate hymen, vaginal in- 
flammations and erosions, vulvar inflammation, 
erosion and fissures, rectal fissures, cervical lacera- 
tions, displacements, ovarian prolapsus, peri-uterine 
inflammation and exudations. (K. C.) The local 
treatment, therefore, covers a wide range. 

Applications of Belladonna ointment, and Warm 
Sitz Baths are sometimes useful. The following sup- 
pository, for its astringent and sedative effects, is 
recommended to allay irritation : 



Ext. Kramerke, 


grs. iss. 


Morph. Hydrochlorat., 


gr. h 


Ol. Theobromse, 


5 L (T.98.) 



Cocaine: — In 2—5 per cent, solutions, is useful for 



VAGINITIS. 593 

application in hyperaesthesic conditions after local 
inflammations have been subdued. 

Faradism: — The application of the secondary fara- 
dic current of tension with the long fine wire will 
sometimes do good. (K. C.) 

Galvanism: — A mild current, with the positive elec- 
trode in the vagina and the negative over the hypo- 
gastrium, has been administered with good effect. 
(Sw.) 

Dilatation: — Slow and cautious dilatation, com- 
mencing with glass plugs sufficiently small to be in- 
troduced without pain, constitutes a useful method 
of treatment ; if the stretching go too far it will cause 
pain and relapse. (W. C.) 



VAGINITIS. 

(See also Leucorrhcea and Gonorrhoea.) 

Borax: — Copious douches of a saturated solution 
with rest and mild cathartics will cure most simple 
acute cases. (K. C.) 

Thiol: — Tampons saturated with a 10-20 per cent, 
solution in glycerine placed in vagina have been used 
with success. 

Marshmallow: — Injections of the decoction are 
used in cases of mild irritation. (Al.) 

Formal: — Injections of a tablespoonful of a 10 per 
cent, solution to 1 quart of water. (T. 96.) 

Ammon. Chloride: — A solution of 3 drachms to the 
pint, used as an injection, has been recommended by 
Dr. Emmett, and for saturating tampons made of 
strips of lint saturated with the solution and allow- 
ing it to remain in situ for twenty-four hours. 

39 



594 DIGEST OF EXTERNAL THERAPEUTICS 

Nitrate of Silver — In chronic forms wash out the va- 
gina with soap and water and paint through a specu- 
lum the entire surface with a nitrate of silver solution 
1-10-20 or full strength ; then insert a piece of steril- 
ized gauze. This the patient should remove the next 
day and employ, later, a douche of warm saturated 
solution of borax ; afterwards repeat the application 
of nitrate of silver. This may be done daily or every 
other day. (K. C.) 

Tannin: — The glycerite is very effective in chronic 
forms in children. (Al.) 

Lysol: — V£-l per cent, solutions as douches fol- 
lowed by non-irritating antiseptic powders, such as 
bismuth, boro-phenate, are recommended for senile 
vaginitis. (Gld.) 



VARICELLA. 

Bathe the patient daily in Carbolized Water and 
keep the skin clean. Apply inunctions of Vaseline, 
Camphorated Oil or thin Starch to relieve the itch- 
ing. (Rd.) 

Caution must be exercised to prevent any injury to 
the eruption on the face. If there is much inflamma- 
tion about the base of the eruption points, apply lint 
saturated with a solution of Calendula, Hydrastis 
or Arnica. (Gn.) 

Zinc or 2 per cent. Ichthyol Ointment, may be ap- 
plied to the crusts on the face. (An.) 



VARICOCELE. 

Cold Douches: — Applied to scrotum and perineum, 



VARICOSE VEINS. 595 

containing 10 per cent, of Tannin, are useful palliative 
measures, together with the suspensory bandage. 
(T. 96.) 

Hamamelis: — Forms a useful lotion when used in 
conjunction with Cold 'Water sponging. 

Ergotine: — The hypodermic injection of this drug is 
said to be effective. About 2 grains of the extract 
is administered for a dose. Bartholow, who com- 
mends the procedure, says: "The needle is inserted so 
that its point will rest among the dilated veins; 
great care must be exercised, however, not to punct- 
ure them. Very severe pain follows and possibly 
faintness, but these effects subside in a few hours un- 
less considerable swelling ensues, which is quite usual. 
A single injection may cure a very extensive varico- 
cele ; more than two are rarely necessary." This pro- 
cedure is looked upon with disfavor by other author- 
ities. 

Operation: — Comparatively few cases will require 
surgical interference ; a well adjusted Suspensory 
worn when in the erect posture will be all that is 
usually necessary. (W.) But when palliative meas- 
ures fail, an operation is demanded for radical cure. 
There are two methods generally employed, subcuta- 
neous ligation (Keyes), and ligation by the open 
method ; the latter is the better. (CI.) 



VARICOSE VEINS. 

Hamamelis: — Applied as a lotion on compresses 
covered with oiled silk, held in position by a well ap- 
plied bandage, is often effective. Use 1 part of the 
tincture to 6 parts of water. (Rd.) 



596 DIGEST OF EXTERNAL THERAPEUTICS. 

Moderate Compression:— Accurately fitting band- 
ages or elastic stockings applied so as to afford that 
support to the blood which the valves can no longer 
give, and to prevent increased distension. The pres- 
sure should be very gentle and uniform, and ap- 
plied in the morning, before the patient puts his feet 
on the floor, and maintained until he retires to bed. 
Should only a small portion of a vein be enlarged, a 
piece of strapping plaster may afford the requisite 
support. Prolonged exercise or standing should be 
avoided. After taking moderate exercise, the limb 
should be raised, and maintained in a horizontal pos- 
ture. Standing is more unfavorable than walking. 
The leg should be well washed and rubbed quite dry 
every morning (Rd.) 

Perchloride of Iron: — 1 part to 3 of water; take 
strips of folded cotton wet with the solution and ap- 
ply over enlarged vein ; cover with oiled silk and ap- 
ply bandage and renew daily. Many cases are said 
to be affected favorably. (Bt.) 

Chloride of Barium: — Prof. Robert, of Dorprat, 
recommends the use of barium applied in the form of 
an ointment to dilated cutaneous veins in the pro- 
portion of 1 drachm to lanolin 1 ounce. The oint- 
ment is to be rubbed on the affected part three times 
a day. (Sm.) 

Intravenous injections to produce coagula are dan- 
gerous, though they have been practiced with success, 
they are generally condemned. The use of Vienna 
paste and similar caustics is obsolete. The only 
method of radical cure is by Subcutaneous Ligation. 

VARIOLA. 

There are three important indications for external 



VARIOLA. 597 

treatment: Exclusion of air from surface of the skin, 
keeping the parts permanently moist to prevent hard- 
ening of the scabs, and lessening of local irritation. 

Vaccination: — Is advisable as soon as possible in 
order to change the disease, if possible, to varioloid. 
(Bt.) 

Exclusion of Light: — There is a prevailing idea that 
light should be excluded from the face to prevent pit- 
ting, though there are some doubts as to the correct- 
ness of this view; it is, however, an expedient rec- 
ommened by many writers, especially the older ones. 
Masks may be worn for this purpose. 

Boric Acid: — Applications of a solution, 1 drachm 
to the pint of water, by means of saturated com- 
presses covered with oiled silk and frequently 
changed, is, together, with the Exclusion of Sun- 
light, a method much practiced. A solution of 1 
drachm to 1% ounces of glycerine applied to the face 
and pharynx by means of a brush is also employed. 
(T. C, Vol. XIII.) 

Carbolic Acid: — This remedy is mentioned by most 
writers and is used in various strengths. It may be 
applied to the face dissolved in olive oil. 

In Germany the following paste is much used : 

Carbolic Acid, 4 to io parts. 

Olive Oil, 40 parts. 

Prepared Chalk, 60 parts. 

Spread on linen and apply to the parts where the eruption is the 
most severe; change every twelve hours. (T. C, Vol. XIII.) 

The following is said to relieve the itching at once : 



Carbolic Acid (Crystals), 


1 part. 


Camphor, 


3 parts. 


Vaseline, 


3-5 parts 



Flexible Collodion: — If applied to the pustules 



598 DIGEST OF EXTERNAL THERAPEUTICS. 

early will have a good effect and protect the face 
from the hands. (F.) If applied late it will do in- 
jury by causing the pus to burrow. At the London 
Smallpox Hospital, Mr. Marson's treatment was to 
wait until the pustules had burst and then apply 
Olive Oil or Glycerine and Rose Water, 1-3. He 
also recommended Cold Cream, Zinc Oxide Oint- 
ment, or Carron Oil. (T. C, Vol. XIII.) 

Hydrarg. Bichlorid.: — Compresses wet with a so- 
lution of grs. ii-iv, water ^vi. Or, 

Hydrarg. Bichlorid., 

Acid. Citric, aa gr. xv. 

Alcohol., (90 per cent.), M lxxx. 

Ether., q. s. ad. ^iss. 

Spray the face for a minute three or four times a day until dessi- 
cation takes place; protect the eyes during the application. (T. 
C, Vol. xiii.) 

Cold Compresses: — A light mask of lint thoroughly 
soaked in a mixture of ice water and glycerine gi— ^i, 
and covered with oiled silk is preferred by Dr. J. W. 
Moore. It is also recommended for the relief of pain 
and swelling. 

Salicylic Acid: — A paste made with 3 parts of the 
acid, 30 of starch, and 70 of glycerine, applied to the 
face by means of a mask ; also to other parts where 
the eruption is marked. 

Ihle's Paste: — A mixture of resorcin 10 grains, with 
2 drachms each of powdered starch, oxide of zinc, 
lanolin and vaseline, is suitable for some cases. (1\ 
C, Vol. XIII.) 

Antiseptic and Astringent Dusting Powders: — In 
the earlier stages of the eruption will possibly relieve 
the heat and irritation. For this purpose the follow- 
ing may be mentioned : Boric Acid, Subgallate of 
Bismuth, or, 



VARIOLA. 599 

Acid. Carbolici, ^ss. 

Zinc. Oxidi, %i. 

Pulv. Lycopodii, ^i. 

(T. C, Vol. xiii.) 

Aristol:— 15 or 20 parts with 100 of vaseline, or 15 
parts with 100 of talc. 

Labarraque's Solution: — 1 percent. (L. T.) 

Cold Cream and Flour: — Made into a thick paste. 
(Rd.) 

Bismuth of Zinc Oxide: — Dusted on after the ap- 
plication of glycerine or olive oil. (Bt.) 

Iodoform: — 31, collodion %i ; paint on pustules fre- 
quently for hastening the drying and preventing the 
extension of pustulation. (T. 98) 

Linseed Meal Poultices: — Sprinkled with Iodoform 
can best accomplish early separation of the crusts 
whether on the face, scalp or elsewhere. A mask of 
the poultice may be made for the face, spreading a 
thin layer on lint and applying a little vaseline on 
which iodoform has been sprinkled; change every two 
hours. (T. C, Vol. XIII.) 

Sponging: — This is both useful and agreeable and 
should be used in most cases. Warm water with a 
little prepared carbolic acid may be employed. (Rd.) 

Hot Baths: — May be used when it is desired to 
hasten the appearance of the eruption. (T. C, Vol. 
XIII.) 

The Prolonged Warm Bath is recommended by 
Skoda, Hebra and others, for desperate cases. The 
patient may be kept in the bath for seven hours 
daily. Great relief has followed this procedure in 
what appeared to be hopeless cases. 

Cold Baths: — Are indicated for hyperpyrexia. (F.) 

Gloves: — May be worn in order to prevent injury 



600 DIGEST OF EXTERNAL THERAPEUTICS. 

to the face by scratching, especially in sleep. Chil- 
dren may have the hands loosely bound. (L. T.) 

The mouth should be frequently and carefully 
cleansed. 

Many other local remedial measures have been sug- 
gested, but the above are those which appear to 
have met with more general approval. Finsen has 
revived the mediaeval treatment of red light, the 
briefest exposure to daylight being regarded as liable 
to produce suppuration. Exclusion of chemical rays 
must be absolute, even the curtains being red. Pack- 
ing for an hour in blankets saturated in W2 pints of 
warmed, not boiled, milk have, it is claimed, been 
successful in arresting the progress of the disease. 

Ventilation: — Is a matter of the greatest import- 
ance. The exit of the contaminated air and the en- 
trance of fresh should be secured. Some observers 
advocate the use of tents, or opening the windows 
and protecting the patient with extra blankets and 
shielding from draughts. 



VOMITING OF PREGNANCY. 

Avoid lying in bed until after breakfast and exer- 
cise care in brushing the teeth, as in some cases this 
produces vomiting. 

Vesication: — Over the 4th and 5th dorsal vertebrae 
is said to have given brilliant results, one application 
being sufficient. (T. 96.) 

Ether or Chloroform Spray against the epigas- 
trium; Collodion painted over epigastrium ; Mechan- 
ical Support of uterus by pessaries or cotton ; chang- 
ing cotton daily; irrigation with a solution of 



VULVITIS. 601 

Potassium Bromide, grs. xx— xl— gi ; the Recumbent 
Posture with the head lower than the body (Bt.), and 
cold to the spine by means of ice bags, are all meas- 
ures which may be given a trial. (Rd.) 

Ichthyol : — Applied on tampons has, it is claimed, 
cured obstinate cases. (T.98.) 

Slight Dilatation of the Os: — This procedure per- 
formed with great care is frequently attended with 
benefit. The vagina should be first douched with a 
sublimate solution of 1-5000, and the parts rendered 
anaesthetic with cocaine ; the finger should then be 
gently introduced and moved around the cervix with 
caution. (G. T.) 

Electricity: — Yoltaism, with feeble intensity and 
long duration, applied to the right pneumogastric, the 
positive electrode being placed between the clavicular 
insertion of the sterno-cleido-mastoid muscle and the 
negative at the umbilicus. Each seance should con- 
tinue from fifteen to thirty minutes. (T. 96.) 



VULVITIS. 

Modern treatment is exceedingly simple, consisting 
in absolute Cleanliness and Antisepsis. In young 
children the best plan is to have them thoroughly 
bathed, and in older girls the vagina and vulva 
should be cleansed as though a plastic operation 
was about to be performed. No special treatment 
of the urethra is required. Douches for very young 
children are best applied by means of a soft rubber 
catheter. Whilst administering, the antiseptic fluid 
may be brought into more thorough contact with 
the interstices of the parts by occasionally closing the 



602 DIGEST OF EXTERNAL THERAPEUTICS. 

vaginal orifice. After washing and irrigating, the 
labia should be kept separated by a piece of lint sat- 
urated with the antiseptic fluid. 

In simple varieties of the disease, strong injections 
are contra-indicated. The only treatment required 
will be that of frequent bathing with Sterilized 
Water and Boric Acid solutions and dusting with 
bland powders such as boric acid. (H. A. H.) 

Potass. Permang.: — An effective douche in the fol- 
lowing strengths: 1—2000 for use at first; afterwards 
gradually increase to 1-1000 or even stronger. (H. 
A. H.) 

Hydrarg. Bichlorid.: — This agent is recommended 
in various solutions, viz: 1—4000—5000, or even 
10,000. (W. A. E.) For frequent use as an injec- 
tion, 1-2000-5000, and for occasional application in 
the diphtheritic variety solutions of from 1—300—500 
have been recommended by Jacobi. 

The following other solutions constitute useful 
antiseptic douches : 

Carbolic Acid, 1-100. 

Boric and Salicylic Acid, (10 grains of the former 
and 5 grains of the latter to the ounce), Nitrate of 
Silver, 1-3000, or even 5000. (W. A. E.) 

Lysol, one-half to one per cent, followed by bland 
powders. (Gld.) 

For the disease appearing after scarlet fever and 
measles : 

Zinc Sulpho-Carbolate, 1-2-100. 

Aluminum Aceto-Tartrate, 1—5-100. 

These solutions are suitable for both irrigation and 
application by saturating lint and laying it over the 
part. They may be used in very young children. 
(Jac) 



VULVITIS. 603 

Other injections useful for children are the follow- 
ing: 

Carbolic Acid, 1-200. 

Alum, 3j-0i. (Sm.) 

Nitrate of Silver: — In the catarrhal variety this re- 
lieves the burning and itching. It may be applied as 
follows: First anaesthetize the part with a 10 per cent, 
solution of cocaine. Then apply the silver solution, 
20-60 grains to the ounce, and cover with a layer of 
vaseline or with a flaxseed poultice. A single applica- 
tion will usually suffice ; if necessary, it may be re- 
peated in 3 or 4 days. (H.) 

Iodoform: — Equal parts with bismuth acts well 
when the discharge is purulent. In some conditions 
an ointment may be preferred, in which case a 
drachm to the ounce may be used. When pruritus is 
a prominent symptom, cocaine may be combined as 
follows : 

Iodoformi, grs. xv-xl. 

Cocainae Hydrochlorat., 3 SS - 

Vaselini, ^i. (H-) 

Lead Acetate: — Cold compresses wet in lead lotion 
are usually all that is necessary in eczematous varie- 
ties. 

When the discharge is profuse the following : 



(Alb.) 



Acid. Boric, 


t} : 


Plumb. Acetat., 


grs. x 


Bismuth. Carbonat., 


3ij- 


Cremoris Alb., 


ad. ^i. 


simple dermal variety : 




Calamin. Prep., 


.l ss - 


Zinc. Oxid., 


311. 


Glycerini, 


3i- 


Aq. Rosse, 


3iij- 



(Alb.) 



604 DIGEST OF EXTERNAL THERAPEUTICS. 

Lead and Opium Wash: — Hare recommends the 
following, applied with compresses when nitrate of 
silver fails : . ' 



Tr. Opii, 




Liq. Plumb. Subacetat., 


aa J;i. 


Aq. Destill., 


Z™. 



When an Astringent is desired for injection and ir- 
rigation, the following can be used with good effect : 

Tannin, 5-100. 

Zinc Sulphate, 1-50. (Hen.) 

Ice Bags: — When pus has formed hot fomentations 
and antiseptic irrigation followed by incision are 
the chief indications of treatment. 

When the disease takes on an aphthous type the 
following : 

Acid. Salicylici, grs. x-^ss. 

Bismuthi Subnit., ^ij. 

Glycerini, ,^i. (H.) 

Carbolized Oil: — This is sometimes of service, ap- 
plied in the strength of 1-60. (Strr.) 

The following bland, non-irritating, antiseptic 
powders are useful after antisepsis : Markosol (Gld.) 
or Boric Acid combined with Zinc or Starch, of 
which the following is an example : 

Pulv. Zinc. Ox. 

Acid. Boraci, aa. ^ss. 

Pulv. Amyli, 3j. (Strr.) 

Sodium Sulphite: — When due to diabetic urine, 
Hare recommends a solution of ^ss-Oj in conjunction 
with separation of the surf aces„ by means of pledgets 
of lint meditated with diachylon ointment. 

Ointments are useful to protect the parts from the 
irritating vaginal discharges. Cold Cream, Zinc 



WARTS. 605 

Oxide Ointment, Benzoated Lard 1 drachm, with zinc 
oxide ointment 1 ounce, may serve this purpose. The 
same may also be used to relieve the heat and dry- 
ness of the part. (H.) 

In the Gonorrhoea! Variety, Rest and Elevation of 
the parts are absolutely essential. The affected re- 
gion must be kept clean and dr}'. Washing every two 
hours with a strong solution of Soda Bicarbonate, 
which should be applied gently, the vaginal orifice 
being separated by the thumb and finger. After 
irrigation, the parts should be thoroughly dried 
and all excess fluid removed by absorbent com- 
presses or old, clean linen or similar material. Dust- 
ing powders, such as those previously mentioned, 
can now be used. In the severer forms Hot Baths 
(not sitz baths), followed by Lead and Opium wash 
or painting the entire vulva with a solution of Ni- 
trate of Silver (grs. xl-1 ounce), will usually effect a 
cure. For the severe burning and throbbing and in- 
flammation, leeches along the groin and perineum 
will afford relief . (Am.) 

In Chronic Cases the vagina and the urethral glands 
are often at fault For these conditions, Free Inci- 
sions and the Curette followed by packing with Iodo- 
form Gauze have been recommended ; also excision 
and the seton ; but the former measures are prefer- 
able. (Am.) 



WARTS. 

Local treatment will vary according to variety and 
locality. Small growths may be removed with a 
pair of curved scissors, and the base touched with 



606 DIGEST OF EXTERNAL THERAPEUTICS. 

nitrate of silver. Larger growths call for the Liga- 
ture or Galvano-cautery, Smaller ones, when pedun- 
culated, may also be conveniently removed by the lig- 
ature. It is advisable to pare down the wart before 
ligating. (Pf.) 

Hydrarg. Bichlorid.: — Localities which are the seat 
of the growths should be frequently washed with a 
bichloride soap and bathed with a solution of 1— 
2000. This should precede all methods of treatment 
according to Van Harlingen, who recommends paint- 
ing the part with a solution in collodion of from 4—8 
grains to the ounce. 

Chromic Acid: — A saturated solution is preferred 
by Crocker for application to common warts. The 
black crust should be removed every few days. 

Salicylic Acid: — A saturated solution in alcohol, re- 
peatedly applied, is usually successful for small 
warts. (Ck.) 

The following are also effective : 



Acid. Salicylici, 


3ss. 


Ext. Cannabis Ind., 


grs. v. 


Collodii, 


fi. 


For seborrhceal warts : 




Acid. Salicylici, 


grs. x-xx. 


Sulphuris Praecip., 


3ss. 


Pulv. Amyli, 


3 SS - 


Ung. Aq. Rosas, 


liv. (Hd.) 



Thuja: — Often useful; apply the tincture fre- 
quently with a brush. (Rd.) 
Caustic Paste: — Viz.: 

Sulphuris, 3 v. 

Glycerini, 3 jss. 

Acid. Acetici, Sijss. (Kap.) 
Apply twice daily. 



WARTS. 607 

Or, 

Pulv. Acid. Arseniosi, grs. vj. 

Ung. Hydrarg., 

Bmpl. Hydrarg., aa q. s. ad. gii. (Hy.) 

Electrolysis: — Is mentioned by Hardaway as the 
best treatment. Complete destruction of the growth 
is not necessary, but merely transfixion with the 
needle. 

Caustics: — In addition to those already mentioned, 
the following are also used : 

Potassa, Acid Nitrate of Mercury, Chloride of 
Zinc, Nitric, Hydrochloric, Acetic, Glacial Acetic, 
and Carbolic Acids, etc. (Duh.) 



APPENDIX L 



MEDICINAL BATHS. 

Acid Bath :— 

Acidi Nitrici Fortis, ^ iss. 

Acidi Hydrochlorici Fortis, ^ i. 

Aquae, C. xxx. 

May be employed in pruritus, urticaria and eczema 
of the papular variety. 

Acidi Muriatici, % x. 

Aquae, C. i. 

Acid baths should be prepared in a wooden tub and 
administered two or three times a week for fifteen or 
twenty minutes at a time. They have been employed 
in treating mercurial poisonings in certain hepatic dis- 
eases with retention of bile. They have been found 
to increase the irritation of jaundice and are rarely 
used at the present time. 

Alkaline Bath: — 

Sodii Carbonatis, ^iv. 

Aquae, C. xxx. 

Or, 

Potassii Carbonatis, £iv. 

Sodii Carbonatis, ^iij- 

Sodii Biboratis, ^ ij . 

Add this powder to 30 gallons of water, with half a pound of 

starch, which has been previously boiled, to make what is known 

as a clear starch. 

40 



610 DIGEST OF EXTERNAL THERAPEUTICS. 

An artificial Vichy bath maybe prepared by adding 
1 part of sodium bicarbonate to 600 parts of water, 
and an artificial Plombieres bath by mixing the fol- 
lowing : 

Sodium Carbonate, 50 parts. 

Sodium Chloride, 2 parts. 

Sodium Sulphate, 6 parts. 

Sodium Bicarbonate, 2 parts. 

Gelatin, 10 parts. 

Water, 30,000 parts. 

These baths are of utility in chronic vesicular and 
squamous skin diseases in prurigo, psoriasis, and 
ichthyosis where a palliative effect is desired. In 
chorea and functional nervous disorders they will 
prove of benefit for their sedative properties. Also 
found beneficial in jaundice where there is much itch- 
ing. Chronic rheumatism, gout, and urinary lithiasis 
may be aided by their use. 

Aromatic Baths : — Prepared by infusing rose- 
mary, lavender, sage, wormwood or other aromatic 
herbs. May be used in chlorosis and sometimes in 
cachectic conditions as cutaneous excitants. The re- 
cipe of the official French code is : 500 grams of 
aromatic spices dissolved in 10 litres of water, add- 
ing the solution to 250 litres of water. 

Arsenical Bath: — Dissolve 15-45 grains of sodium 
arsenate and 3 ozs. of sodium carbonate in a bath tub 
full of water. Thirty baths are said to relieve the 
articular stiffness and pain in rheumatic arthritis. 
Gastric trouble may arise or the joint pain increase, 
but these symptoms will disappear when the sodium 
bicarbonate is withdrawn. 

Another formula is : 

Potassii Sulphureti, ^iv. 

Sodii Arseniatis, grs. xxx-xl. 

Aq. Calidae, C. xxx. 





APPENDIX I. 




orax Bath: — 






Sodii Boratis, 




giv. 


Glycerini, 




Siii. 


Aq. Calidse, 




C. xxx. 



611 



Bromine Bath:— Made by dissolving 20 drops of 
bromine and 2 ounces of potassium bromide in 30 
gallons of water. Advantageous in syphilis and 
squamous skin diseases. 

Carbolic Acid or Creosote Baths: — 

Creosoti sen Acidi Carbolici, 3ij. 

Glycerini, gij. 

Aquae, C. xxx. 

May be employed in pruritus and certain forms of 
squamous eczema. 

Emollient Baths: — Have been employed with good 
effect in cold abscess, lymphangitis, phlebitis, acute 
arthritis and erythematous, scaly and itching skin 
affections. Prepare a bath by boiling 2 parts of 
marshmallow, elder, bran or linseed meal in 10 parts 
of water, adding this decoction to a tub of warm 
water. 

Other emollient baths may be prepared as follows, 
the proportions being 30 gallons of water to the 
quantity of medicant stated : 

Bran, 2-6 pounds. 
Linseed, 1 pound. 
Marshmallow, 4 pounds. 
Potato Starch, 1 pound. 

Gelatin Bath: — Dissolve 1 pound of gelatin or com- 
mon glue in boiling water and add 20 gallons of hot 
water. It is made more effective by adding 1—2 
pounds of bran confined in a muslin bag. These 
baths have been recommended in skin diseases where 



612 DIGEST OF EXTERNAL THERAPEUTICS. 

nervous excitability is a prominent feature. Gelatin 
added to sulphuretted baths renders them less dis- 
agreeable. The French code directs that 500 grams 
of powdered gelatin be dissolved in 2 litres of hot 
water, and added to the bath when required. 

Iodine Baths: — 

Potassii Iodidi, £>vi. 

Iodi, 9ij. 

Aquae, , ^xx. 
Add this mixture to an ordinary bath. 

These baths have been advantageously used in 
scrofula in children and in syphilis and squamous 
skin diseases. For the use of children the formula 
may be modified thus: 

Potassii Iodi, [f)iv. 

Iodi, 9ij. 

Aquae, ^x, 
Add to an ordinary bath. 

Mercurial Baths: — 

Hydrarg. Bichloridi, 3 V - 

Alcoholis, §ij. 

Ammonii Chloridi, ]Ji. 

This mixture may be added to a bath tub of water. 

This bath is used in syphilides, but is contra-indi- 
cated when there is much ulceration for fear of ab- 
sorption. Sublimate baths which have proved use- 
ful in infantile syphilis may be prepared by adding 
10 grains of the bichloride to each bath. A blanket 
should be tied around the neck of the child to cover 
the bath and effectually prevent splashing of the wa- 
ter in its face. 

Mercurial Vapor Baths: — A tin case is furnished 
by instrument makers, containing a small spirit lamp 



APPENDIX I. 613 

with a receptacle over the flame, on which 15—30 
grains of calomel are placed. Surrounding this 
there is a saucer-like receptacle which in filled with 
boiling water. The patient is seated on a common 
cane-bottomed chair, under which the apparatus 
is placed. The lamp is then lighted and the patient 
and chair are completely enveloped in large blankets. 
In about twenty minutes the mercury and water will 
be found to have disappeared. It is advisable not to 
use a towel, as the calomel can be wiped off. The 
bath may also be given by using a hot air box espe- 
cially constructed for the purpose. These forms of 
mercurial baths are almost exclusively used when the 
administration of mercury in this manner is desired. 

Mustard Baths: — Are prepared by dissolving 1-2 
parts of mustard meal in 600 of warm water. Keep 
the patient only a brief time in the bath to prevent 
too great irritation of the skin. 

Used in the algic stage of cholera and serious con- 
gestion of the bowels. The mustard foot-bath, ac- 
cording to the French code, is made by dissolving 
150 grams of mustard meal in a sufficient quantity 
of water not above 104° F. 

Pine Baths: — Made by adding a decoction of pine 
tree shoots to water, or by using the oil of forest 
pine in the proportion of 1 minim of oleum pini sil- 
vestris to the gallon. These baths are useful in gout 
and rheumatism, scrofula, skin diseases and paralysis. 

Saline Baths: — Dissolve 8-10 parts of rock salt or 
sea salt in 300 of water. The French code says 5000 
grams of sea salt to 300 litres of water. 

For sponging use a solution of common salt in the 
proportion of half a pound to 4 gallons of water. 

Sea Baths: — Diminish peripheral circulation and 



614 DIGEST OF EXTERNAL THERAPEUTICS. 

stimulate respiration of the pure sea air. They are 
beneficial in scrofulous diathesis, functional nervous 
disorders and sometimes in mal-assimilation. Ten- 
dency to internal haemorrhage is a contra-indicatiom 

Narcotic Baths: — Boil for an hour 1 part of poppy 
seeds, belladonna leaves, hyoscyamus leaves, datura 
leaves or other narcotic leaves in 10 parts of water. 
Add the decoction to a tub full of -warm water. 
These baths will be found useful in inflammation of 
the genito-urinary organs, peritonitis, enteritis, ex- 
ternal haemorrhoids, etc. 

Sedative Baths: — 1 part of some sedative herb, 
such as valerian, digitalis, or hemlock, in 10 parts of 
water. 

Put the decoction in a tub full of warm water. 
Useful in neurasthenia, hysteria and certain forms of 
neuroses. Inhalation of the fumes should be pre- 
vented by pinning a sheet around the patient's neck. 

Stimulating Baths: — Add alcohol, wine, rum, aro- 
matic alcohol or aromatic vinegar to warm water. 
Beneficial in stimulating circulation and relieving de- 
bility and languor. 

Sulphur Baths: — These are stimulating and are 
useful in cutaneous eruptions, such as herpes, syph- 
ilides, scrofulous diseases, scabies, psoriasis, pityri- 
asis, acne, and impetigo, etc., and in articular rheu- 
matism, catarrhs, lead palsy, chlorosis, and anaemia. 
They are prepared by mixing the f ollowing : 

Sodium or Calcium Monosulphate, 50 parts. 

Sodium Carbonate or Bicarbonate, 50 parts. 

Sodium Chloride, 50 parts. 

Water, 300,000 parts. 

Startin's compound sulphur bath consists of the 
following : 



APPENDIX I. 615 



Sulphur. Praecipit., 


En- 


Sodii Hyposulphit. , 


l'y 


Acid. Sulphuric, Dilut., 


gss. 


Aquae, 


Oj. 


Add this to the contents of the bath tub. 




Another formula : 




Potassii Sulphuret., 


^iv 


Aquae, 


C. xxx. 



Tar Baths: — So-called tar baths are employed for 
rubbing the diseased parts with tar and following 
this treatment with an ordinary warm bath. 

Baths are classified according to temperature, as 
follows : 

Water. Vapor. Air. 

Cold, ..... 33 - 65 

Cool, 6 5 °- 75 

Temperate, . . 75 - 85 

Xepid, .... 85 - 92 90°-ioo° 96°-io6°. 
Warm, .... 92 - 98 ioo°-ii5° io6°-i20°. 
Hot, 98°-ii2° U5 p -i4o° i2o°-i8o.° 



APPENDIX II. 



The formulae of certain compounds, with some ex- 
ceptions, generally known by the author's name : 

Lassar's Paste: — 



Amyli, 






Zinci Oxidi, 




aa gij: 


Vaselini, 




3iv. 


Unna's Paste: — 






Water, 




■ 


Glycerine, 




aa ,^iiss. 


Gelatine, 






Zinc Oxide, 




aa grs. ccc. 


Vlemingckx's Solution: — 




Calcis Vivae, 




3iv. 


Sulphur. Sublimat., 




Ji. 


Aq. Destill., 




1*. 


Boil together with constant 


stirring 


until the mixture measures 6 


aid ounces, then filter. 







Hebra's Diachylon Ointment: — 

Ol. Olivae, S x v. 

Lithargyri, J iii. 

Boil together to a good consistency and add oil of lavender, 2 
drachms. 

Lugol's Solution (Compound Solution of Iodine): — 

Iodine, 5 parts. 

Potassium Iodide, 10 parts. 

Destilled Water, 85 parts. 



618 DIGEST OF EXTERNAL THERAPEUTICS. 

Dobell's Solution: — 

Sodii Biboratis, 

Sodii Bicarbonatis, aa 3 i. 

Glycerini, 3 ii. 

Acid. Carbolici Liquifacti (90 per cent.), MXV. 
Aquae, qs. ad. 3*viii. 

Thiersch's Solution (Liq. Boro-Salicylicus): — 
Acid. Salicylici, grs. xv. 

Acid. Borici, 3i ss - 

Aquae, q. s. ad. 5 xv i- 

Seiler's Antiseptic Tablets: — 

Sodium Chloride, 5 grains. 

Sodium Biborate, 5 grains. 

Eucalyptol, ¥ V grain. 

Thymol, T V grain. 

Oil of Gaultheria, ^ grain. 

Sodium Bicarbonate, 5 grains. 

Sodium Benzoate, 2T grain. 

Sodium Salicylate, 2T grain. 

Menthol, ^ grain. 

A tablet containing the above is dissolved in 2 tablespoonfuls of 
water, and the solution used with the atomizer for cleansing the 
mucous surfaces of the nose and throat. 

Labarraque's Solution: — This is an aqueous solu- 
tion of several chlorine compounds of sodium, chiefly 
NaCIO and NaCl and containing at least 2.6 by 
weight of available chlorine. 

Wilkinson's Ointment: — 

Sulphuris, 

Ol. Cadini, aa ^ss. 

Sapo. Viridis, 

Adipis, 

Cretae Preparatae, 

Burow's Liquor or Solution: — 

Lead Acetate, 
Alum Acetate, 
Distilled Water, 



aa 31. 


3 iiss. 


1 part. 


5 parts. 


100 parts. 





APPENDIX n. 




Churchill's Tincture of Iodine: — 




Iodi, 




% iiss. 


Potassii Iodidi, 




3 SS - 


Aquae, 




^iv. 


Alcoholis, 


q. s. 


ad. ^xvi. 


Churchill's Iodine 


Caustic: — 




Iodi, 




3ii- 


Potassii Iodidi, 




3iv. 


Aquae, 




fr 


Calamine Lotion:- 






Pulv. Calaminae, 




9ii. 


Zinci Oxidi, 




^ss. 


Glycerini, 




M. xv, 


Aq. Rosae, 




§i. 



619 



Billroth' s Transfusion Fluid: — 

Sodii Chloridi, £i. 

Sodii Carbonatis, grs. xx. 

Sodii Phosphatis, grs. iij. 

Amtnoniae Carbonatis, grs. xx. 

Alcoholis, M. clx. 

Aq. Destill., q. s. ^xvi. 

Dissolve the sodium salts in the distilled water, sterilize the solu- 
tion by heat, then add the ammonium carbonate and alcohol, cork 
the bottle well and allow it to cool. 

Hayem's Artificial Serum: — 

Sodium Hydrate, grs. xvss. 

Sodium Chloride, 9iv. 

Sodium Sulphate, grs. xxxix. 

Boiled Water, ^ iii. 

Inject 1-4 pints at a temperature of 100. ° 

Normal Saline Solution :— Clinical experience has 
demonstrated that a solution containing the normal 
proportion of sodium chloride answers well in every 
way for the purpose of transfusion. The proportion 
of the chloride to sterilized water is 0.6 per cent. 



KEY OF REFERENCES, 



A American Text-Book of Surgery. 

Wm. Keen, M. D., and Wm. White, M. D., Phil- 
adelphia, 1892. 

A. C. S. . . The Various forms of Pruritus Cutane- 
ous and their Treatment. 
R. W. Taylor, M. D., Archives of Clinical Sur- 
gery, August, 1877. 

Ad Rectal and Anal Surgery. 

Edwin W. Andrews, M. D., Chicago, 1888. 

Ag Practice of Surgery. 

D. Hayes Agnew, M. D., Philadelphia, 1878. 
Ak Science and Practice of Medicine. 

Wm. Aitkin, M. D., Philadelphia, 1872. 

Al Local Therapeutics. 

Harrison Allen, M. D., Philadelphia, 1893. 

All Diseases of the Rectum. 

W. and H. W. Allingham, M. D., London, 1896. 

Alb. . . . System of Medicine. 

Thomas C. Allbutt, M. D., New York, 1897. 

Am American Text-Book of Obstetrics. 

R. C. Norris, M. D., and R. E. Dickinson, M. D., 
Philadelphia, 1895. 

An Practice of Medicine. 

James Anders, M. D., 2nd Ed., Philadelphia, 
T898. 

And. . . . Treatise on Diseases of the Skin. 

T. McCall Anderson, M. D., London, 1887. 



622 DIGEST OF EXTERNAL THERAPEUTICS. 

A. S. ... The Tallerman Treatment by Dry Super- 
heated Air. 

Arthur Shadwell, M. D., London, 1898. 

A. W. . . . Diseases of Children. 

Henry Ashby, M. D., and G. A. Wright, M. B., 
London, 1889. 



B Materia Medica and Therapeutics. 

Roberts Bartholow, M. D., 9th Ed., New York, 
1897. 

Ba Diseases of the Nose and Pharynx. 

James Ball, M. D., 2nd Ed., London, 1894. 

Bac. . . . Manual of Otology. 

Gorham Bacon, M. D., New York, 1898. 

Bck. . . . Diseases of the Ear. 

Albert H. Buck, M. D., New York, 1898. 

B. H. . . . American Text-Book of Genito-Urinary 
Diseases. 

L. B. Bangs, M. D., and W. A. Hardaway, M. D., 
Philadelphia,, 1898. 

Bk Notes on the Non-Surgical Treatment of 

Boils, Carbuncles and Felons. 

L. D. Bulkley, M. D., New York, 1898. 

Bl Contributions to this Book. 

Charles C. Boyle, M. D., New York. 

B. M. J., L, 9.8. Local Treatment of Painful Ulcera- 
tion by Orthoform. 

E. S. Yonge, British Medical Journal, Vol. I., 
1898. 

B. M. J., 6, 9, 88. On the Treatment of Tubercular 
Leprosy by Excision. 

Beaver Rake, British Medical Journal, June 9, 
1888. 



KEY OF REFERENCES. 623 

B. M. P., 8, 13, 96. Traitement de la Coquelouche 
par la Methode de Rabinschek. 

Bulletin Medicale de Paris, Sept. r3, 1896. 

B. M. S. J., 11, 22, 94. Treatment of So-called In- 
curable Purulent Pleurisies by the 
Siphon. 

C. G. Cunningham, M. D., Boston Medical and 
Surgical Journal, Nov. 22, 1894. 

Bn. .... System of Diseases of the Ear, Nose and 
Throat. 

Chas. E. Burnett, M. D., Philadelphia, 1893. 

Boe. . . . Special Formulae. 

William Boericke, M. D., San Francisco, Cal. 

Bos. . . . Diseases of the Nose and Throat. 

Francke H. Bosworth, M. D., 3rd Ed., New 
York, 1897. 

Bp. .... Diseases of the Ear, Nose and Throat. 

S. S. Bishop, M. D., New York, 1897. 

Br Manual of Diseases of the Ear. 

Thomas Barr, M. D., Glasgow, 1896. 

B. T. ... Pathology and Treatment of Venereal 
Diseases. 

Freeman J. Burnstead, M. D., and Robert W. 
Taylor, M. D., Philadelphia, 1883. 

Bt Physiological Materia Medica. 

William H. Burt, M. D., 4th Ed., Chicago, 1888. 

Bw. . . . International System of Electro-Thera- 
peutics. 

H. R. Bigelow, M. D., Philadelphia, 1894. 



C The Prescriber. 

John H. Clarke, M. D., 2nd Ed., London, 1886. 



624 DIGEST OF EXTERNAL THERAPEUTICS. 

Ca The Surgeon's Hand-Book. 

F. M. Caird, M. D., and C. W. Cathcart, M. D., 
Philadelphia, 1889. 

C. G., 8, 24, 98. Das Vorlanfuge Ergebnis der Vapor- 
ization. 

Ludwig Pincus, M. D., Centralblatt fiir Gyno- 
kologie, Sept. 24, 1894. 

Ch Special Formulae. 

E. I. Church, M. D., New York. 

Ck Diseases of the Skin. 

H. Radcliffe Crocker, M. D., Philadelphia, 1893. 

CI Genito-Urinary and Venereal Diseases. 

Bukk G. Carleton, M. D., New York, 1898. 

Cln. ... A Practical Treatise on Diseases of Men. 

Bukk G. Carleton, M. D., New York, 1898. 

Cob. . . . The Newer Remedies. 

Virgil Coblentz, Ph. D., New York, 1896. 

Cool. . . , Cooley's Encyclopedia of Practical Re- 
ceipts. 
R. V. Tuson, F. C. S., 6th Ed., New York, 1897. 

Cp Text-Book of Gynaecology. 

A. C. Cowperthwaite, M. D., Chicago, 1898. 

Cr A Practical Treatise on Appendicitis. 

Howard Crutcher, M. D., Chicago, 1898. 



D Diseases of Women. 

F. H. Davenport, M. D., 3rd Ed., New York, 
1898. 

Dch. , . . Diseases of the Ear. 

Edward B. Dench, M. D., New York, 1894. 

Den. . . . System of Surgery. 

Fredericks. Dennis, M. D., Philadelphia, 1895. 



KEY OF REFERENCES. 625 

D. H. ... Working Hand-Book of Diseases of the 
Genito-Urinary System and Syphilis. 

F. E. Doughty, M. D., and G. P. Holden, M. D., 
Philadelphia, 1897. 

Du Practitioner's Reference Book: 

Richard J. Dungleson, M. D., Philadelphia, 1877. 

Dud. . . . Treatise on Gynaecology. 

E. C. Dudley, M. D., New York, 1898. 

Duh. . . . Cutaneous Medicine. 

Louis A. Duhring, M. D., Philadelphia, 1898. 

Erb. . . . Hand-Book of Electro-Therapeutics. 

Dr. Wilhelm Erb. Translated by Dr. L. Putzel, 
New York, 1893. 

Ev Phthisiology, Historical and Geograph- 
ical. 

G. A. Evans, M. D., New York, 1888. 

Ew. . . . Disease of the Stomach. 

C. A. Ewald, M. D., New York, 1898. 

F Reference Hand-Book of Practical 

Therapeutics. 

Frank E. Foster, M. D., New York, 1897. 

Fid Manual of Diseases of the Ear. 

George P. Field, M. D., London, 1894. 

Ful. . . . Diseases of the Male Sexual Organs. 
Eugene Fuller, M. D., Philadelphia, 1895. 

Ga Key-Notes of Materia Medica. 

Charles Gatchell, M. D., 7th Ed., Chicago, 1895. 

G. A. 0. . . Diseases of the Heart and Aorta. 

G. A. Osborne, M. D., New York, 1898. 
41 



626 DIGEST OF EXTERNAL THERAPEUTICS. 

Ger. .... Aseptic and Antiseptic Surgery. 

Alfred G. Gerster, M. D., New York, 1888. 

G. J. . . . Text-Book of Practical Obstetrics. 

E. H. Grandin, M. D., and G. V. Jarman, M. D., 

2nd Ed., New York, 1895. 

Gld. . . . American Text-Book of Medicine and 
Surgery. 
G. M. Gould, M. D., Philadelphia, 1898. 

Gn Practice of Medicine. 

William C. Goodno, M. D., Philadelphia, 1897. 

Gt Diseases of Rectum and Anus. 

S. G. Gant, M. D., Philadelphia, 1896. 

H System of Practical Therapeutics. 

H. A. Hare, M. D., Philadelphia, 1892. 

Ha New Remedies. 

E. M. Hale, M. D., 5th Ed., New York, 1880. 

H. A. H. . . Progressive Medicine. 

H. A. Hare, M. D., Philadelphia, 1899. 

Hb Diseases of the Skin. 

Ferdinand Hebra, M. D. Translated by C. 
Hilton Fagge, M. D., London, 1866. 

Hd Clinical Manual of Skin Diseases. 

W. A. Hardaway, M. D., 2nd Ed., Philadelphia, 
1898. 

Hel System of Surgery. 

William Tod Helmuth, M. D., 5th Ed., New 
York, 1887. 

Hen. . . . Lectures on Diseases of Children. 

E. Henoch, M. D., New York, 1882. 

H. F. ... Hospital Formulary of the Department 
of Public Charities. 
2nd Ed., New York, 1898. 



KEY TO REFERENCES. 627 

Hg Pharmacodynamics. 

Richard Hughes, M. D., 6th Ed., New York, 1886. 

HI System of Surgery. 

T. Holmes, M. D., Philadelphia, 1889. 

Hit Diseases of Infancy and Childhood. 

Emmet Holt, M. D., New York, 1897. 

Ho Special Formulae. 

Henry Houghton, M. D., New York. 

Hpl. . . . Materia Medica and Therapeutics. 

Charles I. Hempel, M. D , 2nd Ed., New York, 
1864. 

Ht Diseases of the Nervous System. 

Eudwig Hirt, M. D., New York, 1893. 

Hy Treatise on Diseases of the Skin. 

James N. Hyde, M. D.. Philadelphia, 1893. 

Ing Diseases of the Chest, Throat and Nasal 

Cavities. 

E. Fletcher Ingalls, M. D., New York, 1898. 

Iv. ...» Diseases of the Nose, Throat. 

Horace F. Ivins, M. D., Philadelphia, 1893. 

Ja Diseases of the Skin. 

George T. Jackson, M. D., 2nd Ed., New York, 
1898. 

Jac Therapeutics of Infancy and Childhood. 

A. Jacobi, M. D., Philadelphia, 1898. 

J. C. G., 5, 93. The Treatment of Suppurating Bub os 
by Injections of Iodoform. 

F. N. Otis, M. D., Journal of Cutaneous and 
Genito-Urinary Diseases, May, 1893. 

J. C. S. . . Compend of Diseases of the Skin. 

Jay C. Schamberg, M. D., Philadelphia, 1898. 



628 DIGEST OF EXTERNAL THERAPEUTICS. 

J. de P. . . Traitement du Chancre par le Gaiacol. 

Djealeleddin — Moukhtar, Journal de Paris, Sept. 
26. 1897. 

J. M. C.j 4, 16, 96. Extract from Editorial. 

Indian Medical Review, Calcutta, April 4, 1896. 

K Surgery of the Rectum and Pelvis. 

Charles B. Kelsey, M. D., New York, 1897. 

Kap. . . . Pathology and Treatment of Diseases 
of the Skin. 

M. Kaposi, M. D., New York, 1895. 

K. C. ... Clinical Gynaecology. 

J. M. Keating, M. D., and H. C. Coe, M. D., 
Philadelphia, 1897. 

Kp Diseases of the Skin. 

J. R. Kippax, M. D., Chicago, 1895. 



L., II., 97. . Excerpt. 

Lancet, Vol. II., 1897, page 73. 

L. B, ... The Throat and Nose and Chest Dis- 
eases. 

Lennox Browne, M. D., 3rd Ed., Philadelphia, 
1890. 

L. T. ... System of Practical Medicine. 

A. L. Iyoomis, M. D., and W. G. Thompson, 
M. D., New York, 1898. 

M Diseases of the Nose and Throat. 

Morrell Mackenzie, M. D., Philadelphia, 1890. 

Mac. . . . Diseases of the Eye. 

N. L. MacBride, M. D., New York, 1897. 

M. C, 14, 98. Excerpt. 

Medical Chronicle, Dec, 1898. 



KEY TO REFERENCES. 629 

Mc Surgical Diseases and Treatment. 

J. W. McDonald, M. D., Philadelphia, 1898. 

M. H. . . . Metropolitan Hospital, Department of 
Public Charities, New York. 

M. M. W., 5, 17, 98. The Local Employment of 
Superheated Steam. 

Fedor Krause, M. D., Miinchener Medicinische 
Wochenschrift, May 17, 1898. 

M. N., 12, 10, 98. Treatment of Constipation. 

Geo. R. Eockwood, M. D., Medical News, 
Dec. 10, 1898. 

Mor. . . . System of Genito-Urinary Diseases, Syph- 
ilography and Dermatology. 

Prince C. Morrow, M. D., New York, 1893. 

M. R., 9, 10, 96. Excerpt. 

Medical Record, Oct. 10, 1896. 

M. R., 9, 1, 97. Some Plain Rules for Operating in 
Appendicitis. 

G. F. Shrady, M. D., Medical Record, Jan. 9, 
1897. 

M. R., 5, 11, 98. Dermatitis Venenata. 

J. Sobel, M. D., Medical Record, Nov. 5, 1898. 

Mr. ... . Essentials of Practice of Medicine. 

Henry Morris, M. D., Philadelphia, 1890. 

M.T., 9,97. Excerpt. 

Medical Times, Sept., 1897. 

M. T., 11, 97. A General Criticism of Herman 
Mynder's Book on Appendicitis. 
M. O. Terry, M. D., Medical Times, Nov., 1897. 

M. T., 4, 98. Recent Improvements in the Treatment 
of Chronic Heart Disease by Exercises 
and Carbonated Bran Baths. 
Thomas E. Satterthwaite, M. D., Medical Times, 
April, 1898. 



630 DIGEST OF EXTERNAL THERAPEUTICS. 

M.T.,9,98. Excerpt. 

Medical Times, Sept., t 898. 

M. T., 12, 98. Prostatic Hypertrophy, Bottini's 
Galvano-Caustic Treatment. 
Bukk G. Carleton, M. D., Medical Times, Dec, 

1898. 

Mus. . . . Prescribing and Treatment for Infants 
and Children. 
P. E. Muskett, M. D., 2nd Ed., London, 1892. 

M. W. . . . Extra Pharmacopoeia. 

W. Martindale, F. C. S , and W. W. Westcott, 
M. B., 9th Ed., London, 1898. 

N. ... . National Dispensatory. 

Stille, Maisch and Caspari, 5th Ed., New York, 
1896. 

N. 0. ... System of Diseases of the Eye. 

W. F. Norris, M. D., and A. Oliver, M. D., 
Philadelphia, 1898. 

Ny Text-Book of Diseases of the Eye. 

Henry D. Noyes, M. D., New York, 1890. 

N.- Y. M. J., 2, 7, 98. Local Examination of Diseases 
of the Upper Rectum and Sigmoid 
Flexure. 

J. P. Tuttle, M. D., New York Medical Journal, 
July 2, 1898. 

N. Y. M. J., 7, 26, 93. The Treatment of Granulat- 
ing Wounds. 

William W. Van Arsdale, M. D., New York 
Medical Journal, July 29, 1893. 

Os Principle and Practice of Medicine. 

William Osier, M. D., 3rd Ed., Philadelphia, 

1898. 



KEY TO REFERENCES. 631 

P Materia Medica and Therapeutics. 

C. D. F. Phillips, M. D., 3rd Ed., New York, 
1882. 

Pep. . . . Text-Book of Practice and Theory of 
Medicine. 

William Pepper, M. D., Philadelphia, 1894. 

Pf Diseases of the Skin. 

Henry G. Peffard, M. D., and R. M. Fuller, 
M. D., New York, 1891. 

Pk Treatise on Surgery by American Au- 
thors. 
Roswell Park, M. D., Philadelphia, 1896. 

Ply. .... Science and Practice of Midwifery. 

W. F. Playfair, M. D., 7th Ed., New York, 1898- 

P. M. . . . . Diseases of the Nose, Throat and Ear. 

P. McBride, Edinburgh, 1892. 

P. M. J. . . Protargol, a Substitute for Nitrate of 
Silver in Opthalmia Neonatorum. 

F. E. Cheney, M. D., Phila. Medical Journal, 
Sept. 3, 1898. 

P. M. J., 9, 24, 98. Use of Formalin in Blepharitis. 

H. Moulton, M. D., Phila. Medical Journal, 
Sept. 24, 1898. 

Pp System of Medicine. 

William Pepper, M. D., Philadelphia, 1885. 

i 
Pt. .... Materia Medica and Therapeutics. 

S. O. Potter, M. D., 6th Ed., Philadelphia, 1897. 
Pz Treatise on Gynaecology. 

S. Pozzi, M. D., New York, 1897. 

Q Dictionary of Medicine. 

Richard Quain, M. D., Rev. Ed., 1894. 

Qy. ... Diseases of the Nose and Throat. 

G. H. Quay, M. D., Philadelphia, 1897. 



» 



632 DIGEST OF EXTERNAL THERAPEUTICS. 

R Handbook of Therapeutics. 

Sidney Ringer, M. D., 13th Ed., New York, 1897. 

Rd. ...... Text-Book of Medicine and Surgery. 

E. H. Ruddock, M. D., London, 1884. 

Rk Medical and Surgical Uses of Electricity. 

A. D. Rockwell, M. D., New Ed., New York, 
1896. 

Ro Clinical Manual of Diseases of the Eve. 

D. B. St. John Roosa, M. D., New York, 1894. 

Rv Excerpt. 

Medical Review of Reviews, Sept., 1898. 

Saj Annual and Analytical Encyclopedia of 

Practical Medicine. 

C. E. de M. Sajous, M. D., New York, 1898. 

S. B. ... Hydrotherapy. 

Simon Baruch, M. D., New York, 1898. 

S. F. ... Notes on Nosophen. 

Stahlmann and Fulton, New York, 1892. 

Sh Diseases of the Skin. 

J. V. Shoemaker, M. D., 2nd Ed., New York, 
1892. 

Sj Annual of Universal Medical Science. 

C. E. de M. Sajons, M. D., New York, 1896. 

Sm Materia Medica and Therapeutics. 

J. V. Shoemaker, M. D., 4th Ed., Philadelphia, 
1897. 

Sn. .... Saunder's Pocket Formulary. 

William M. Powell, M. D., Philadelphia, 1891. 

St Manual of Practical Medicine. 

A. A. Stevens, M. D., Philadelphia, 1896. 

Str Diseases of the Ear. 

Charles Sterling, M. D., New York, 1885. . 



KEY TO REFERENCES. 633 

Strr. . . . American Text-Book of Diseases of 
Children. 

Louis Starr, M. D., Philadelphia, 1894. 

Sw Practical Gynaecology. 

G. R. Southwick, M. D., Boston, 1891. 

S. W. M. . . Fat and Blood. 

S. Weir Mitchell, M. D., 3rd Ed., Philadelphia, 
1884. 

T. 96. . . . International Medical Annual. 
E. B. Treat & Co., New York, 1896. 

T. 97. . . ' . International Medical Annual. 
E. B. Treat & Co., New York, 1897. 

T. 98. . . . International Medical Annual. 

E. B. Treat & Co., New York, 1898. 

Ta. . . . .» Index of Diseases and their Treatment. 

T. H. Tanner, M. D., 2d Ed., Philadelphia, 1877. 

T. C, Vol. V. Twentieth Century Practice — Diseases 
of the Skin, Vol. V. 

Thomas L. Stedman, M. D., New York, 1896. 

T. C, Vol. IX. Twentieth Century Practice — Dis- 
eases of the Nervous S3^stem, Vol. IX. 

Thomas L. Stedman, M. D., New York, 1897. 

T. C, Vol. XIII. Twentieth Century — Infectious 
Diseases, Vol. XIII. 
Thomas L. Stedman, M. D., New York, 1898. 

T. G., 9, 15, 96. Editorial. 

Therapeutic Gazette, Sept. 15, 1896. 

Thn. . . . Schott's Treatment of Chronic Diseases 
of the Heart. 

W. B. Thorne, M. D., New York, 1897. 

Tn Special Formulae. 

Irving Townsend, M. D., New York. 



634 DIGEST OF EXTERNAL THERAPEUTICS. 

Tre System of Surgery. 

Frederick Treves, M. D., Philadelphia, 1897. 

T. W. . . . Manual of Diseases of Children. 

J. W. Taylor, M. D., and W. H. Wells, M. D., 
Philadelphia, 1898. 

Ty Practice of Medicine. 

James Tyson, M. D., Philadelphia, 1899. 

U. S. ... United States Dispensatory. 

Wood, Remington and Sadtler, ryth Ed., Phila- 
delphia, 1894. 

Vn. . . , . Handbook of Diagnosis and Treatment 
of Skin Diseases. 

Arthur Van Harlingen, M. D., 3d Ed., Philadel- 
phia, 1895. 

W. .... System of Surgery. 

John A. Wyeth, M. D., 3d Ed., New York, 1898. 

Wa Practical Therapeutics. 

E. I. Waring, M. D., 3rd Ed., Philadelphia, 1886. 

Wt. .... Diseases of the Nose and Throat. 

W. L. Watson, M. D., London, 1896. 

W. A. E. . . Cyclopedia of Diseases of Children, 
Vol. V. 

W. A. Edwards, M. D., Philadelphia, 1899. 

W. C. . . . Practice of Surgery. 

B. F. Curtis, M. D., and H. R. Wharton, M. D„ 
Philadelphia, 1898. 

Wh Dermatitis Venenata. 

J. C. White, M. D., New York, 1872. 

Whar. . . Minor Surgery and Bandaging. 

H. R. Wharton, M. D., Philadelphia, 1893. 



KEY TO REFERENCES. 635 

W. M. . . . Genito Urinary and Venereal Diseases. 
J. W. White, M. D., and E. Martin, M. D., 
Philadelphia, 1897. 



Y Manual of Medical and Clinical Thera- 
peutics. 

J. B. Yeo, M. D., Philadelphia, 1893. 



INDEX. 



PAGE. 

Abscess, Acute, i 

" Cold, 4 

Acne Simplex, 7 

" Rosacea, . 14 

Adenitis, 16 

Agalactia, 18 

Alopecia, 18 

" Areata, 21 

" Syphilitica, 24 

Amenorrhoea, 24 

Anaesthesia, 25 

Aneurism, 31 

Angina Pectoris, 33 

Anosmia, 34 

Anthrax, see Malignant Pustule, 355 

Anus, Fissure of, 34 

" Fistula of, 37 

" Prolapsus of , see Prolapsus of Rectum 461 

" Pruritus of , see Pruritus, . . • * " 39 

Aphthae, see Stomatitis, 511 

Apoplexy, 39 

Appendicitis, 41 

Arthritis, , 42 

Ascarides L/imibricoides, 44 

" Vermiculares, 44 

Aspergillus, 44 

Asphyxia, 45 

Asthma, • 49 

Auditory Meatus, Furuncle of, 382 

Balano-Posthitis, 53 

Bedsores, 54 

Bites of Insects, 56 



638 INDEX. 

PAGE. 

Bites of Serpents, 57 

Bladder, Irritability and Neuralgia of, 59 

Blepharitis, 59 

Blisters, 60 

Boils, 61 

Bone, see Caries and Necrosis of, 107 

Bowels, Obstruction of, Intussusception, Fsecal Impaction, . 64 

Brain, Concussion of, 66 

Breasts, Swollen and Painful, Inflammation of, 67 

Breath, Offensive, 69 

Bromidrosis, 70 

Bronchiectasis, 76 

Bronchitis, Acute, 73 

" Capillary, 74 

" Chronic, 75 

Bubo, 77 

Bunion, 81 

BurnSj 82 

" of the Eyelids, 89 

" of Minor Character, 89 

Bursitis, 89 

Cancer, 90 

" of Larynx, 96 

" of Rectum, 97 

" of Uterus, 97 

Cancrum Oris, 103 

Carbuncle, ........ 104 

Caries and Necrosis of Bone, 107 

Caries of Teeth, 109 

Cellulitis, see Phlegmonous Erysipelas, 251 

Cerumen, Inspissated and Impacted, . . no 

Cervicitis, Acute, 224 

" Chronic, 224 

Cervix, Erosion of, 224 

Chafing, see Erythema Intertrigo, 253 

Chancre, Hard, in 

Chancroid, 112 

" Subpreputial, 116 

" Phagedsenic, 117 



INDEX. 639 

PAGE. 

Chaps and Fissures of Hands, Dips, 117 

Chilblains, . , 119 

Chloasma, ...... . . 121 

Cholera Asiatica, 123 

" Infantum, , .. 125 

Chordee, 127 

Chorea, 128 

Cicatrices, 128 

Cold, Effects of, 130 

" General Depression from, . 131 

Colic, ........... 132 

Collapse, . . . 132 

Coma,, 134 

Comedo, 136 

Condylomata, 137 

Congestion, Cerebral, 223 

Conjunctiva, Blenorrhcea of, 138 

Conjunctivitis, Acute Catarrhal, ... 139 

Granulosa, see Trachoma, . . • • 535 

" Diphtheritic, 141 

Phlyctenular, 142 

Purulent, 143 

Constipation, 145 

Contusions, 147 

Convulsions, 149 

" Epileptic, 149 

" Hysterical, 149 

" Infantile, . 149 

Puerperal, 151, see also Uraemic poisoning, . 588 

Uraemic, see Uraemic poisoning, 588 

Cornea, Ulcers of , 152 

" Opacities of, 153 

Corns, 155 

Coryza, see Acute Rhinitis, 474 

Cough, . 156 

Croup, Simple Catarrhal, 158 

" Membranous, 159 

Cystitis, Acute, . .•"".. 161 

" Chronic, . . 162 

Cysts, 166 



640 INDEX. 

PAGE. 

Dandruff, see Pityriasis, 423 

Dermatitis Herpetiformis, . 166 

" Venenata, 167 

Diphtheria, .... 170 

Dysentery, Acute, 179 

Chronic, 181 

Dysmenorrhcea, 181 

Dysphagia, 182 

Dyspnoea, 183 

Earache, 184; see also Otitis Media, 385-391 

Ecchymosis, see Contusions, 147 

Ecthyma, 184 

Eczema, Acute and Subacute, . 185 

Intertrigo, . 191 

Chronic, 192 

in Children, ... 198 

of Regions, 200 

of the Beard, 203 

Breast and Nipple, 203 

Ears, 204 

Eyelids, 205 

Face, . 206 

Genitals, 208 

Hands and Feet, 209 

Legs, . . . . .211 

Lips, 212 

Nails, •••.... 213 

Scalp, 214 

Universal, 217 

Seborrhceicum, 218 

Emphysema, 220 

Empyema, 220 

Encephalitis, 223 

Endocarditis, Acute, 224 

" Chronic, see Valvular Disease of Heart, .... 300 

Endocervicitis, Acute, 224 

" Chronic, 224 

Endometritis, Acute, 228 

" Mild Forms, 228 



INDEX. . 641 

PAGE. 

Endometritis, Gonorrhoeal, 228 

" Septic, following. Operations, 228 

" Grave Forms, Puerperal, 229 

" Chronic, 231 

Enuresis, . 237 

Epididymitis, . . 238 

Epilepsy, see Convulsions, 149 

Epistaxis, 240 

Epithelioma, 243 

Erysipelas, 247 

" Phlegmonous, 251 

Erythema, Simplex, 252 

" Intertrigo, . . 253 

Favus, 255 

Felon, 256 

Freckles, 332 

Frost Bite, 130 

Galuctorrhoea, 257 

Ganglion, 257 

Gangrene, Moist, 258 

Dry, • . . . 259 

" Hospital, .', 259 

Gastralgia, 261 

Gastritis, ... 261 

Gingivitis, Simple, 262 

Glanders, 263 

Glands, Enlarged, 263 

Gleet, ,. . 265 

Goitre, Bronchocele, 270 

" Exophthalmic, . 273 

Gonorrhoea, 275 

" in the Female, 283 

Glossitis, 270 

Glottis, (Edema of, see (Edematous Laryngitis, 330 

Gout, Acute, 286 

" Chronic, see Arthritis, .... 42 

Gums, Spongy and Ulcerated, 287 

Hsematemesis, 288 

42 



642 INDEX. 

PAGE. 

Haematuria, 289 

Haemoptysis, 288 

Haemorrhage, • 289 

" from Bone, 290 

" Larynx, 290 

" Post-partum, 291 

" from Rectum, 292 

Haemorrhoids, External, 293 

" Internal, 296 

Hay Fever, 298 

Headache, 300 

Heart, Chronic Diseases of, 300 

Heat, Prostration by, 513 

Hemiplegia, see Paralysis, . . 394 

Hernia, Strangulated, 304 

Herpes Labialis, see Herpes Simplex, 307 

" Circinatus, see Trichophytosis Corporis 556 

" Progenitalis, 306 

" Simplex 307 

" Zoster, 307 

Hiccough, 309 

Hirsuties, ... 310 

Hordeolum, 311 

Hydrocele, 311 

Hyperhidrosis, see Bromidrosis, 70 

Hysteria, * ■ 313 

Ichthyosis, 315 

" Hystrix, 316 

Impetigo, 317 

" Contagiosa, 317 

Influenza, see Acute Rhinitis, . 474 

Ingrowing Toe Nail, , 318 

Insomnia, 323 

Intertrigo, see Erythema Intertrigo, 253 

Iritis, 320 

Keloid, 324 

Keratitis, . ■ . . 323 

Laryngismus Stridulus, 325 



INDEX 643 

PAGE. 

La^ngitis, Acute Catarrhal, 326 

" Chronic Catarrhal, 327 

" Acute CEdematous, 330 

Lentigo, see Freckles, 332 

Leprosy, 333 

Leucorrhcea, 334 

Lichen Ruber, . . . 338 

Locomotor Ataxia, 339 

Lupus Erythematosus, , 343 

" Vulgaris, 347 

Lumbago, see Muscular Rheumatism, ..... -472 

Malignant Pustule, 355 

Measles, 356 

Meningitis, Acute Cerebral (Lepto-Meningitis), 358 

Cerebro-Spinal, ' 358 

Menorrhagia and Metrorrhagia, 359 

Metritis, see Endometritis, . • 228 

Miliaria, 361 

Milium, 361 

Moles, see Naevus Pigmentosus, 363 

Mucous Patches, 362 

Mumps, 400 

Naevus Pigmentosus, 363 

" Vascularis 364 

Nasal Polypus, 366 

Naso-Pharyngeal Catarrh, Chronic, see Chronic Rhinitis, . . 367 

Neuralgia, . . . 369 

Neurasthenia, see Hysteria, • 3 J 3 

Nipples, Fissured and Sore, 375 

Nodes, 377 

Onychia, 377 

Oophoritis, see Pelvic Inflammation, 402 

Ophthalmia Neonatorum, . 378 

Orchitis, Acute, 381 

Ostitis, 406 

Otitis Externa, Circumscripta, Furuncle of the Auditory 

Meatus, ,. .. 382 

" Externa, Diffusa, : 383 



644 INDEX. 

PAGE. 

Otitis Media, Acute Catarrhal, 385 

" " Chronic Catarrhal, . 387 

" " Acute Purulent, 389 

" " Chronic Purulent, 391 

Paralysis, 394 

Parotiditis, 400 

Pediculosis Capititis, • 400 

" Pubis, 402 

Pelvic Inflammation, Acute, . 402 

" " Chronic, 402 

Pemphigus, 403 

Pericarditis, 406 

Periostitis, •. 406 

Peritonitis, • 407 

" Tubercular, 408 

Pernicious Malarial Fever, 409 

Pertussis, 409 

Phagedaena, 413 

Pharyngitis, Acute Catarrhal, 417 

" Chronic. Catarrhal, 419 

Pharynx, Adenoid Growths of, ... 415 

Phlebitis, 422 

Phlegmasia, Alba Dolens, see Phlebites, 422 

Pityriasis Capitis, 423 

" Versicolor, . 426 

Pleurisy, Acute, 428 

Pleurodynia, see Muscular Rheumatism, 472 

Pneumonia, Acute Croupous, .... 430 

Powder Stains, 435 

Prickly Heat, 361 

Proctitis, -435 

Prostatitis, Acute, 439 

" Chronic, 440 

Pruritus, ... 443 

Ani, 448 

Scroti, 451 

Vulvae, 452 

Psoriasis, 454 

Pyorrhoea Alveolaris, : 459 



INDEX. 645 

PAGE. 

Quinsy, see Acute Suppurative Tonsillitis, 547 

Rabies, 459 

Ranula, 460 

Rectum and Anus, Prolapsus of, 461 

Rectum, Ulcer of, . 463 

Rheumatism, Acute Articular, 466 

Chronic Articular, 468 

" Muscular, 472 

Rhinitis, Acute, . . . ' 474 

Simple Chronic, 478 

" Atrophic, , 481 

Hypertrophic, - 486 

Ringworm, see Trichophytosis, 548-556 

Scabies, 489 

Scalds, 28 

Scarlet Fever, 493 

Sciatica, see Neuralgia, 369, and Muscular Rheumatism, . . 472 

Scorbutus, 497 

Seborrhoea, 497 

Shock, see Collapse, 132 

Sigmoid Flexure and Upper Colon, Diseases of, 500 

Spermatorrhoea, 501 

Sprain, 506 

Stranguary, 510 

Stricture, Spasmodic, 510 

Stomatitis, 511 

Stye, see Hordeolum, 311 

Sunstroke, 513 

Sycosis Coccogenica, 514 

Synovitis, Acute, 519 

" Chronic, . 520 

Syphilides, . . 529 

Syphilis, 521 

of the Larynx, 525 

of the Nose and Naso-pharynx, 526 

Syphilitic Ulcers, 531 

Tattoo Marks, 533 

Tetanus, 533 



646 INDEX. 

PAGE. 

Tongue, Fissure of, , 542 

Tonsil, Hypertrophy of the Lingual, 546 

Tonsils, Hypertrophy of, 543 

Tonsillitis, Acute Follicular, 546 

" Acute Suppurative, Quinsy, 547 

Toothache, 540 

Torticollis, see Muscular Rheumatism, . . 472 

Trachoma, 535 

Trichophytosis Barbae, 548 

Capitis, 550 

Corporis, 556 

Tuberculosis of the Larynx, 557 

" " Lungs, 562 

Typhoid Fever, 574 

Ulcers, 579 

" Healthy, 580 

" Irritable, . 580 

" Inflamed, 580 

" Fungoid, 581 

" (Edematous, 581 

' ' Indolent, Callous or Chronic, 581 

"* Varicose, 584 

" Foul, Sloughing and Gangrenous, 585 

" Tubercular, 586 

" Scrofulous, 586 

" Phagedenic, see Phagedena, 413 

" Syphilitic, see Syphilis, 521 

Uremic Poisoning, 588 

Urethritis, Chronic Anterior, 265 

" " Posterior, ' . 266 

" in Females, 590 

Urine, Retention of, 59° 

Urticaria, 59 1 

Uvula, Relaxed or Elongated, 59 2 

Vaginismus, 59 2 

Vaginitis, 593 

Varicella, 594 

Varicocele, 594 



INDEX. 647 

PAGE. 

Varicose Veins, 595 

Variola, , 597 

Vomiting of Pregnancy, 600 

Vulvitis, " 600 

Warts, 606 







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